mental health case studies for high school students

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Meeting the Mental Health Challenge in School and at Home

From kindergarten through college, educators are experimenting with ways to ease the stress students are facing — not only from the pandemic, but from life itself.

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By Eilene Zimmerman

This article is part of our Learning special report about how the pandemic has continued to change how we approach education.

Last year, Leticia Guerrero-Castaneda’s 11-year-old son, Isaiah, was struggling. He was in the fifth grade when the pandemic shutdown occurred, and his reaction was to shut himself down; he became pathologically afraid of germs and contamination.

“He wouldn’t come out of his room and became afraid of touching anything,” Ms. Guerrero-Castaneda recalled.

That led to depression and anxiety, which affected not only Isaiah, but his family. By the time he returned to the classroom, Isaiah was in seventh grade and, like many students, was experiencing behavior problems.

Seeking help, Ms. Guerrero-Castaneda attended two workshops run by CHAMP (Community Health Action Mental Perseverance) last spring at Norma Cooms Elementary School in Pasadena, Calif. Parents there wrote narratives of their experiences related to events that impacted their families — like Covid and school shootings — and processed those experiences with other parents.

“We came to see we were not alone,” Ms. Guerrero-Castaneda said. “We learned different coping mechanisms and were told not to ignore our feelings or our kids’ feelings. Most of us were worried about how our children will be affected in the long run. And there was a sense of great comfort in being able to talk about it with other parents.”

CHAMP was created by three faculty members at Pacific Oaks College in Pasadena: Camille Huggins and Cassandra Peel , professors of social work, and Giovanni Hortua , an adjunct professor of history and Latin American studies. Dr. Huggins said the workshops provided parents a tool kit for coping with grief and loss, for themselves and their children.

“This is a self-care exercise that gets them to reflect on their experience, to analyze and make sense of it,” she said.

Ms. Guerrero-Castaneda guided her son toward individual therapy and is emotionally supporting him as he works his way through his fears. “He started journaling and drawing as a way to express what he’s feeling,” she said. “And little by little, things are improving.”

CHAMP is one of many innovative programs and strategies schools nationwide have put in place to help students, many of whom are struggling with the toll the last two-and-a-half years has taken on their mental health. That toll has been cumulative, because distress among young people has been rising for a decade.

In 2019, the C.D.C. reported that the percentage of high school students with persistent feelings of sadness or hopelessness was nearly 40 percent, up from 26 percent in 2009, and almost 20 percent of students in 2019 had seriously considered suicide. Two years later, in 2021, 44 percent of high schoolers were feeling sad or hopeless . And suicide is now the second leading cause of death among children 10- to 14-years-old.

“The pandemic really just turned up the volume on a soundtrack that was already playing,” said Amber Childs , a clinical psychologist and an assistant professor of psychiatry at Yale School of Medicine. That soundtrack, she said, includes “racism, discrimination against L.G.B.T.Q. youth, a lack of gender-affirming care, the overturning of Roe v. Wade, school shootings, climate change.

“The pandemic happened among a groundswell of issues. And then you have children seeing adults at war with one another on social media and in the news,” Dr. Childs said. “I’ve had teenagers say, ‘Where are all the grown-ups? If they are fighting and can’t solve this, what does it mean for us?’ That can be terrifying for a kid.”

College students are also struggling. Emotional stress is one of the top reasons students consider dropping out of college, according to a report released in April from Gallup-Lumina, a private foundation that advocates for equity in higher education. Colleges and universities have lost nearly 1.3 million students since the pandemic began, according to the National Student Clearinghouse Research Center

The Connection Project, developed by Joseph Allen , a clinical psychologist and psychology professor at the University of Virginia, helps ease difficult developmental transitions, like the one from high school to college, and guides students toward forming authentic, meaningful friendships. (The high school version is known as the Teen Connection Project.) The program grew out of a study Dr. Allen conducted that followed 184 13-year-olds in Charlottesville, Va., for 25 years to learn about the friendships and social connections they formed.

The research showed that deep, early friendships enhanced a teen’s sense of belonging and reduced loneliness and depression, both in high school, college and beyond. The teen project consists of semester long weekly meetings of about eight to 10 students led by two trained and supervised student facilitators (in high schools, facilitators are trained adults).

“We know over the last 10 years that rates of loneliness and depression among young people has gone up more than 60 percent,” Dr. Allen said; data from a randomized trial of the Teen Connection Project published in May showed a reduction in loneliness and depressive symptoms. The project’s groups use specially designed exercises to help students connect with each other across social groups in a short period of time.

The program was developed in conjunction with Wyman , an organization based in St. Louis that develops evidence-based programs for teens. It’s now in seven high schools and the University of Virginia, where it began in 2018 as Hoos Connected and served 27 students; this year about 1,000 will participate.

Megan Turner, 21, a Hoos Connected facilitator and former group member, said Hoos Connected helped a great deal with her transition from high school to college. “For the first time I was surrounded by people where I felt I could share when I wasn’t doing well, and I received a lot of empathy and kindness.”

True North , a program at Boston College, began as a class for students participating in internships and evolved into a campuswide initiative. It was developed by Belle Liang , a clinical psychologist and psychology professor at the college, and Tim Klein , a licensed clinical social worker and lecturer there. True North’s structured exercises and discussions guide students toward determining their core values, skills, character strengths and the contribution they want to make in the world and connects that to life after college.

Dr. Liang’s research has shown that when students feel a sense of purpose in their work, they are buffered against academic and social stress. She and Mr. Klein are co-authors of the book, “ How To Navigate Life: The New Science of Finding Your Way in School, Career and Beyond .”

The TRAILS (Transforming Research into Action to Improve the Lives of Students) program trains educators and school counselors to support students in grades K-12 by equipping them with coping skills to use when they feel anxious, stressed and depressed. That’s important because mental health crises have been rising for younger students , yet schools can’t find enough clinicians to help them.

TRAILS started as a program within the University of Michigan’s psychiatry department and the Eisenberg Family Depression Center . It grew so fast during Covid that in May it became an independent fiscally sponsored project of the Tides Center , a nonprofit that supports social change. TRAILS’ social and emotional learning curriculum focuses on teaching children how to recognize what they are feeling and strategies for coping.

“Kids usually sleep, listen to music and spend time on their phones, none of which, the evidence shows, makes them feel better,” said Elizabeth Koschmann, a psychologist and founder and executive director of TRAILS. Instead, students are taught skills grounded in cognitive behavioral and mindfulness practices, like reframing how they think about a situation or recognizing and stopping negative feelings and thoughts about themselves.

The program also offers professional development and coaching, a suicide risk management protocol and a library of resources teachers and counselors can use when working with students. About 750 schools have partnerships with TRAILS and about 8,000 teachers nationwide use its social and emotional learning curriculum. Materials in the program’s resource library are free for school mental health professionals and pulled from its website 2,500 times each day during the school year.

Students living in rural areas face significant challenges accessing mental health services, according to the Rural Health Information Hub , a national clearinghouse for information on rural health issues. Rural communities often lack local psychologists, psychiatrists or social workers and suicide among youth has historically been highest in rural areas.

The Rural Behavioral Health Institute , a nonprofit established in 2020, aims to reduce youth suicide in rural regions, starting with Montana, where young people commit suicide at more than twice the rate of young people nationwide, according to data from the Center for Children Families, and Workforce Development at the University of Montana.

In March 2021, the institute piloted its Screening Linked to Care program in one Montana high school to identify students at risk for suicide, quickly evaluate them and refer them to care. Janet Lindow , an associate professor of psychiatry at the University of Kansas Medical Center and executive director of the institute, has been a suicide researcher for six years.

“It used to be unheard-of to have a kid below age 12 being suicidal, but it is now not uncommon to have 10- and 11-year-olds,” she said.

This year, the program will offer psychiatric services, case management to help families connect to mental health providers and virtual group therapy for students in different schools with the same mental health needs. The institute screened 41 students in the 2020-21 academic year; last year, its program screened more than 1,000 children at 10 schools in five Montana counties. About 10 percent were identified as having a high risk of suicide, and about one-third needed mental health services.

Screening is critical because children who are suicidal are less likely to ask for help than other children and when they do, they usually ask a peer, Dr. Lindow said. “And their peers don’t know what to do.”

Many schools across the country have less formal approaches to helping students. Cumberland County School district in Fayetteville, N.C., created “calm corners” and “reset rooms” in every kindergarten through fifth-grade classroom with items like beanbag chairs, large pillows, art activities and fidget toys, which can help with focus and ease anxiety.

Reset rooms for sixth through 12th graders have an area where students can write in journals using prompts on the wall, punching bags, adult coloring books, Silly Putty, even illustrated instructions for breathing exercises and yoga (and yoga mats).

Dyann Wilson, who counsels sixth- through eighth-grade students at Brabham Middle School, part of Willis Independent School District in Willis, Texas, helps students build virtual “reflection rooms,” which they can visit when they feel their emotions are starting to affect their behavior.

“Students add things that make them feel better, calmer or ground them, like inspirational quotes, art, and links to music and games,” Ms. Wilson said, adding that these coping skills are crucial. “If we don’t help kids find proper ways to manage their emotions, we fail them.”

Eilene Zimmerman is a regular contributor to The New York Times and a former columnist for the Sunday Business section. She is the author of the book “Smacked: A Story of White-Collar Ambition, Addiction, and Tragedy” and a clinical social worker in Southern California.

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How School Affects Mental Health In High School Students

May 2, 2022

Recent data from the CDC provides insight into the young minds impacted by the COVID-19 pandemic, revealing more than a third of high school students reported experiencing poor mental health during the pandemic . Unfortunately this is just one startling statistic amongst a decade-long trend of declining mental health in adolescents . It’s clear students are in crises, but the CDC didn’t just bear bad news—there’s a silver lining.

The good news: students who felt supported and cared for at their schools during the pandemic were almost 20 percent less likely to report repeatedly feeling sad and hopeless. This tells us schools are uniquely positioned to come to the aid of their students, so now more than ever it’s important to provide mental health support in schools.

Why Is Mental Health Important For Students?

According to the National Alliance on Mental Illness, half of all mental health conditions manifest by age 14 . Identifying mental illness and developing healthy coping skills at an early age can impact an adolescent’s entire adulthood. Prioritizing mental health is paramount in order to grow.

Unfortunately, school itself can sometimes be a major stressor in a student’s life. A 2021 public health advisory issued by the U.S. Surgeon General identified bullying, academic pressure, and missing out on educational opportunities as just a few examples of how school affects mental health. Instead of learning, making friends, and finding their place in the world, poor mental health in high school students may make it difficult to focus in class and cause them to act out and withdraw from others.

In the same advisory, the U.S. Surgeon General called on educators to step up however they can to provide support and mental health resources for high school students.

Mental Health Support In Schools

Though the growing focus on mental health in high school students signifies change, potential solutions aren’t always clear to school districts aiming to address the issue. In the Child Mind Institute’s “ The Impact of the COVID-19 Pandemic on Children’s Mental Health ” 2021 report, less than half of the schools surveyed shared their school or district was prepared to handle emotional issues amongst their students, such as economic hardship, anxiety, acting out, trauma, etc. More than a third felt they were somewhat prepared, but that’s still a long way from ready to take the necessary actions to improve mental health in schools.

According to the Morgan Stanley Alliance for Children’s Mental Health, educators returning to in-person learning during the pandemic reported a desire for more training in how to actively support students with emotional/behavioral challenges, identify these students, and locate external resources for these students. Knowing what’s missing as educators to help shape young minds is a great start to seeking improvement for mental health support in schools.

To be able to take appropriate action as needed, educators must keep an open mind and be willing to learn best practices to integrate mental health support in their schools. Adaptability and empathy for all can go a long way in the school system.

How To Improve Mental Health In Schools

P - We know educators care about their students and have already had to adjust to so many changes over the past couple of years. But the reality of the mental health burden facing high school students means there’s always more that can be done, and there are several critical improvements schools can make right now, according to the U.S. Surgeon General.

Learn to recognize signs of mental health distress in students and when to take action.

As we shared earlier, educators have a prime position in a student’s life to pay attention to their social and academic development. If a teenager withdraws from teachers and peers or shows a drastic change in academic performance and/or behavior, educators can take that next step to speak with the student and potentially refer them to a school counselor or nurse who is better equipped to help.

Foster a positive, safe environment for all students.

Enforcing anti-bullying policies, encouraging inclusivity, and actively educating students and their families about mental health sets the tone for a positive environment where students can feel safe. Students spend 180 days in the classroom every school year—establishing a feeling of belonging within the school is essential.

Prioritize students with higher needs or those with higher risk of mental illness.

Poverty, trauma, disabilities, and personal/family mental health challenges are just a few factors that put certain teenagers at higher risk for mental illness. Pay particular attention to those in the classroom who are already at risk.

Thankfully, educators seeking change within their schools don’t have to do it alone. The right resources can help guide you toward revitalized mental health support in schools.

Mental Health Resources For High School Students

If you’re an educator or school administrator still feeling stuck or wanting to implement lasting changes, there are hundreds of resources devoted to improving mental health support in schools. Here, we’ve identified a few mental health resources you can utilize to get started providing support for high school students.

• At Mindspring, we have a wealth of educational resources geared toward those living with mental illness, their loved ones, and the community at large. Two free webinars we offer periodically are “Depression and Suicide in Youth” and “Creating a Low-Stress Environment and Minimizing Crises”—stay tuned to see when these and other impactful webinars join our lineup !
• Mental Health First Aid offers training courses to help participants identify risk factors and warning signs of mental health and substance abuse concerns, how to help someone in a crisis, and where to go for additional support.
• UnityPoint Health provides Youth Prevention Education to local schools to help introduce classrooms to mental health basics and lessen the stigma associated with mental health in high school students.
• The National Alliance on Mental Illness devotes a web page to providing mental health support in schools .
• The Suicide Prevention Resource Center shares resources to prevent adolescent suicide .

Concerned How School Affects Mental Health For Iowa High School Students? Contact Mindspring.

There might not be one simple solution to how to improve mental health in schools, but identifying the resources to help your school make a difference plants the seeds for success. At Mindspring, we work with individual Iowans impacted by mental illness as well as families, workplaces, and the community at large. Much like yourself as an educator, our goal is to empower those we work with through education and support. Contact us online , call our office at 515-277-0672 , or send an email to [email protected] to learn more about how we can help you create lasting change for students.

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Open Access

Peer-reviewed

Research Article

Depression, anxiety and stress among high school students: A cross-sectional study in an urban municipality of Kathmandu, Nepal

Contributed equally to this work with: Anita Karki, Bipin Thapa

Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Software, Writing – original draft, Writing – review & editing

* E-mail: [email protected] (PB); [email protected] (AK)

Affiliation Central Department of Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal

Roles Data curation, Formal analysis, Methodology, Software, Visualization, Writing – original draft, Writing – review & editing

Affiliation Department of Child, Adolescent Health and Maternal Care, School of Public Health, Capital Medical University, Beijing, China

Roles Writing – review & editing

Affiliation Department of Community Medicine, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal

Roles Conceptualization, Methodology, Supervision, Writing – review & editing

• Anita Karki, 
• Bipin Thapa, 
• Pranil Man Singh Pradhan, 

• Published: May 31, 2022
• https://doi.org/10.1371/journal.pgph.0000516
• Peer Review
• Reader Comments

Depression and anxiety are the most widely recognized mental issues affecting youths. It is extremely important to investigate the burden and associated risk factors of these common mental disorders to combat them. Therefore, this study was undertaken with the aim to estimate the prevalence and identify factors associated with depression, anxiety, and stress among high school students in an urban municipality of Kathmandu, Nepal. A cross-sectional study was conducted among 453 students of five randomly selected high schools in Tokha Municipality of Kathmandu. Previously validated Nepali version of depression, anxiety, and stress scale (DASS-21) was used to assess the level of symptoms of depression, anxiety and stress (DAS). Multivariable logistic regression was carried out to decide statistically significant variables of symptoms of DAS at p-value<0.05. The overall prevalence of DAS was found to be 56.5% (95% CI: 51.8%, 61.1%), 55.6% (95%CI: 50.9%, 60.2%) and 32.9% (95%CI: 28.6%, 37.4%) respectively. In the multivariable model, nuclear family type, students from science or humanities faculty, presence of perceived academic stress, and being electronically bullied were found to be significantly associated with depression. Female sex, having mother with no formal education, students from science or humanities faculty and presence of perceived academic stress were significantly associated with anxiety. Likewise, female sex, currently living without parents, and presence of perceived academic stress were significantly associated with stress. Prevention and control activities such as school-based counseling services focusing to reduce and manage academic stress and electronic bullying are recommended in considering the findings of this research.

Citation: Karki A, Thapa B, Pradhan PMS, Basel P (2022) Depression, anxiety and stress among high school students: A cross-sectional study in an urban municipality of Kathmandu, Nepal. PLOS Glob Public Health 2(5): e0000516. https://doi.org/10.1371/journal.pgph.0000516

Editor: Khameer Kidia, Brigham and Women’s Hospital, UNITED STATES

Received: February 22, 2022; Accepted: May 2, 2022; Published: May 31, 2022

Copyright: © 2022 Karki et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: The data that support the findings of descriptive analysis of this study are available in Figshare with the identifier given below: https://doi.org/10.6084/m9.figshare.19203512 The data that support the findings of inferential analysis of this study are available in Figshare with the identifier given below: https://doi.org/10.6084/m9.figshare.19203491 .

Funding: The authors received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.

Introduction

Mental disorders contribute to a huge proportion of disease burden across all societies [ 1 ]. Among them, depression, anxiety and stress are the leading causes of illness and disability among adolescents [ 2 ]. The physical, psychological, and behavioral changes that occur throughout adolescence predispose them to a variety of mental health issues [ 3 ]. Despite this, mental health and mental disorders are largely ignored and not given the same importance as physical health [ 4 ].

The existing community-based studies conducted among high school students of various parts of Nepal have reported a wide range of prevalence of symptoms of depression and anxiety. The prevalence of depressive symptoms has been reported to range from 27% to 76% [ 5 – 7 ]. Likewise, the limited studies conducted in Nepal have estimated the proportion of symptoms of anxiety to range from 10% to 57% [ 7 – 9 ]. A nationwide survey conducted in Nepal revealed the prevalence of mental distress among adolescents (13-17years) to be 5.2% [ 10 ]. The Global School Health Survey which was a nationwide survey conducted in 2015 reported anxiety among 4.6% of the students [ 11 ].

Previous studies have revealed that sex [ 12 – 16 ], staying away from home [ 17 ], grade [ 12 , 14 , 16 ], stream of study [ 18 ], academic performance and examination related issues [ 7 , 19 ], cyber bullying [ 20 ] were linked with depression. Likewise, sex [ 8 , 21 ], grade of students and type of school i.e., public or private [ 8 ], family type [ 17 ], not living with parents, educational level of parents [ 21 ] and high educational stress [ 22 ] had been the determinants of anxiety as per previous studies.

High school education is an important turning point in the life of academic students in Nepal [ 23 ]. As the educational system becomes more specialized and tough in high school, the students become more likely to experience stress at this level. This might put them at risk of developing common mental disorders such as depression, anxiety and stress (DAS). However, there is a paucity of research studies that have assessed DAS among high school students in Nepal.

Exploring the magnitude and risk factors of symptoms of DAS are very crucial to combat the burden of adolescent mental health issues [ 24 ]. However, due to limited access to psychological and psychiatric services as well as the significant social stigma associated with mental health issues, anxiety and depression in early adolescence frequently go undiagnosed and untreated, particularly in developing countries such as Nepal. Therefore, this study aimed to estimate the prevalence and identify factors associated with the symptoms of DAS among high school students in an urban municipality of Kathmandu, Nepal.

Materials and methods

Study setting, design, and population.

This was a cross-sectional survey conducted in randomly selected high schools of Tokha Municipality, Kathmandu District in province no. 3 of Nepal. The data collection period was from 27 th August to 11 th September 2019. This municipality was formed on 7 December 2014 by merging five previous villages. It has an area of 16.2 sq.km. and comprises 11 wards [ 25 , 26 ]. The municipality is rich in cultural and ethnic diversity [ 25 ]. According to Nepal government records as of 2017, there were total 218,554 students in Tokha municipality in 82 schools. High school students were the study population for this study [ 26 ]. In Nepal, high school students comprise of grade 11 and grade 12 students. The high school differs from lower schooling level since the students have the opportunity to enroll in specialized areas such as science, management, humanities and education. High school are also popularly known as 10+2 [ 27 ].

Sample size calculation and sampling technique

Sample size was estimated using the formula for cross-sectional survey [ 28 ], n = Z 2 p(1-p)/ e 2 considering the following assumptions; proportion (p) = 0.24 [ 12 ], 95% confidence level, the margin of error of 5%. The estimated proportion used for sample size calculation was based on proportion of symptoms of anxiety i.e., 24%, as reported by a similar study conducted in Manipur, India [ 12 ].

After calculation, the minimum sample size required was 280. After adjusting for design effect of 1.5 to adjust variance from cluster design and assuming non-response rate of 10%, final sample of 467 was calculated. Two-stage cluster sampling was used. A list of all high schools of Tokha municipality was obtained from the education division of the municipality. Out of twelve high schools (8 private schools and 4 public schools), five schools were randomly selected. Within each selected high school further two sections each of grades 11 and 12 were randomly selected. A total of 20 sections were selected, 4 from each selected school, and all the students from the selected sections were included in the study.

Data collection tools

A structured questionnaire was prepared based on our study objectives which was divided into three sections. The first section included information about socio-demographic, familial and academic characteristics of the students. The second section included two item question to assess socializing among the students which was based on a previous study by Vankim and Nelson [ 29 ], two questions to assess bullying among the students based on 2019 Youth Risk Behavior Survey [ 30 ] and one item question to assess perceived academic stress. The third section consisted of Depression, Anxiety and Stress Scale (DASS-21) used to assess level of symptoms of depression, anxiety and stress among the students.

DASS-21 is a psychological screening instrument capable of differentiating symptoms of DAS. Depression, anxiety, and stress are three subscales and there are 7 items in each subscale. Each item is scored on a 4-point Likert scale which ranges from 0 i.e., did not apply to me at all to 3 i.e., applied to me very much. Scores for DAS were calculated by summing the scores for the relevant items. and multiplying by two [ 31 ]. A previously validated Nepali version of DASS-21 was obtained and used for data collection. Nepali version of the DASS-21 has demonstrated adequate internal consistency and validity. However, in the validation paper, the construct validity of the tool was evaluated against life satisfaction scale and not a systematic diagnostic tool [ 32 ]. Reliability for the symptoms of DAS was tested by Cronbach alpha. Cronbach alpha values for DAS were 0.74, 0.77, and 0.74 respectively.

Data collection procedure and technique

Data was collected after obtaining permission from the municipality’s education division as well as individual high schools. The questionnaire was in both English and Nepali language and had been pre-tested among 45 high school students of neighboring municipality. Self-administered anonymous questionnaires were distributed to students in their respective classrooms and requested for participation. An orientation session was conducted for the filling the questionnaire before distribution. Written informed consent was taken from all students prior to data collection whereas additional written parental consent was obtained from students below 18 years of age. One of the investigators herself collected the data from students. After data collection, a session on depression, anxiety, and stress along with the importance of discussing it with the guardians/ teachers and asking for help was conducted.

Study variables

The study variables are described in Table 1 .

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https://doi.org/10.1371/journal.pgph.0000516.t001

Data analysis

Compilation of data was done in EpiData 3.1 and then exported to IBM SPSS Statistics version 20 (IBM Corp., Armonk, NY) for cleaning and analysis. Descriptive analysis was performed. Frequency tables with percentages were generated for categorical variables, while mean and standard deviation (SD) were calculated for continuous variables.

Binary logistic regression was performed to identify associated factors of symptoms of DAS. Firstly, we performed univariate analysis in which each co-variate was modeled separately to determine the odds of DAS. Those variables with p-value <0.15 in univariate analysis were identified as candidate variables for multivariable logistic regression. In multivariable logistic regression, a p-value of < .05 was considered to be statistically significant and strength of association was measured using adjusted odds ratio (AOR) at 95% confidence interval.

Multicollinearity of variables was tested before entering them in the regression analysis. No problem of multicollinearity was seen among the variables (the highest observed VIF was 1.25,1.10 and 1.13 for symptoms of DAS respectively. The goodness of fit of the regression model was tested by the application of the Hosmer and Lemeshow test; the model was found to be a good fit (P >.05).

The regression model was explained by the equation:

Log [Y/ (1-Y)] = b 0 + b 1 X 1 + b 2 X 2 + b 3 X 3 … ..b n X n + e

Where Y is the expected probability for the outcome variable to occur, b 0 is the constant/intercept, b 1 through b n are the regression coefficients and the X 1 through X n are distinct independent variables and e is the error term.

Ethical approval and consent

The study protocol was approved by the Institutional Review Committee (IRC) of the Institute of Medicine, Tribhuvan University (Reference no. 23/ (6–11) 76/077). Approval to conduct this study was also obtained from the education division of Tokha Municipality (Ref: 076/077-23) and respective school authorities. A written informed consent (in the Nepali language) was obtained from the students before the data collection to assure their willingness to participate and no identifiers were listed in the questionnaire to make it anonymous and confidential. Parental consent was obtained for students who were under the age of 18. No incentives were provided.

Sociodemographic, academic and contextual characteristics of the students

The research questionnaire was distributed to a sample of 468 high school students, one of whom refused to participate in this study, with a response rate of 99.78%. Responses from 14 students were excluded due to incompleteness. This study presents the analysis on a total of 453 students.

The mean age of the students was 16.99 years (SD = ±1.12), ranging from 14 to 22 years. The proportion of female students (54.1%) was higher than male students (45.9%). Majority of the students were found to be currently living with their parents i.e., 65.8%. Around 70% of the students were from nuclear family. Regarding parent’s educational level, majority of the students responded that their father as well as mother had attained secondary level of education i.e., 31.6% and 33.3% respectively.

With regards to academic characteristics, more than two- third of students i.e., 69.5% were from private high schools while the remaining 30.5% were studying in a government or public high school. More than half i.e. (53.4%) of the students studied in grade eleven. About half of the students i.e., 50.6% were from management faculty. Only 3.8% students reported to have failed in the previous examination.

It was noted that about 60% of students perceived themselves to be stressed due to their studies. Most students were low socializing i.e., 60.9%. Around one-tenth students reported being bullied electronically in the past 12 months (10.2%). Similar proportion of students i.e., 10.4% also reported being bullied on school property in the past 12 months ( Table 2 ).

https://doi.org/10.1371/journal.pgph.0000516.t002

Level of symptoms of DAS among the students

The prevalence of symptoms of DAS was found to be 56.5% (51.8%, 61.1%), 55.6% (50.9%, 60.2%) and 32.9% (28.6%, 37.4%) respectively. About a quarter of students showed moderate level of symptoms of depression and anxiety i.e., 25.8% and 24.5% respectively. On the other hand, symptoms of mild stress were most prevalent among the students. i.e., 14.8% ( Table 3 ).

https://doi.org/10.1371/journal.pgph.0000516.t003

Factors associated with symptoms of depression

The results from multivariable logistic regression analyses for correlates of symptoms of depression are shown in Table 4 . The variables that remain in the final model were age, type of family, father’s education, mother’s education, type of school, grade, faculty, perceived academic stress, and bullied electronically as these variables had p-value less than 0.15 in the univariate model. In the final model, nuclear family type (AOR: 1.64, 95% CI: 1.06–2.52), students from science/humanities faculty (AOR: 1.58, 95% CI: 1.05–2.40), presence of perceived academic stress (AOR: 1.62, 95% CI: 1.08–2.44) and bullied electronically in past 12 months (AOR: 2.84, 95% CI: 1.34–5.99) were significantly associated with symptoms of depression.

https://doi.org/10.1371/journal.pgph.0000516.t004

Factors associated with symptoms of anxiety

The results from multivariable logistic regression analyses for correlates of symptoms of anxiety are shown in Table 5 . The variables that remained in the final model were age, sex, mother’s education, stream/ faculty, perceived academic stress, bullied electronically, and bullied on school property (p<0.15). Female sex (AOR: 1.82, 95% CI: 1.23–2.71), no formal education attained by the mother (AOR: 1.63, 95% CI: 1.08–2.47), students from science or humanities faculties (AOR: 1.50, 95% CI: 1.01–2.21), and presence of perceived academic stress (AOR: 1.93, 95% CI: 1.30–2.87), and were significantly associated with symptoms of anxiety.

https://doi.org/10.1371/journal.pgph.0000516.t005

Factors associated with symptoms of stress

The results from multivariable logistic regression analyses for main correlates of symptoms of stress are shown in Table 6 . The variables that remained in the final model were sex, current living status, grade, stream / faculty, perceived academic stress, bullied electronically and bullied on school property. In the final model, female sex (AOR: 1.54, 95% CI: 1.01–2.34), currently living without parents, (AOR: 1.70, 95% CI: 1.11–2.61), and presence of perceived academic stress (AOR: 2.11, 95% CI: 1.36–3.26) were significantly associated with stress symptoms.

https://doi.org/10.1371/journal.pgph.0000516.t006

In our study, the prevalence of depressive symptoms among high school students was found to be 56.5%. The existing community-based studies conducted among high school students of various parts of Nepal have reported a wide range of prevalence of depressive symptoms. A study by Gautam et al. reported that more than one quarter i.e., 27% of high school students in a rural setting of Nepal showed depressive symptoms [ 6 ]. Similarly, in a study conducted by Bhattarai et. al. in four schools of a metropolitan city in Nepal, it was found that more than 2/5 th i.e., 44.2% students exhibited depressive symptoms [ 5 ]. Similar proportion of depressive symptoms i.e., 41.6% was also reported by Sharma et. al in a study conducted among adolescent students of public schools of Kathmandu [ 9 ]. The prevalence estimated by these studies are lower than the findings of our study [ 5 , 6 , 9 ]. On contrary, a single high school study by Bhandari et al reported depressive symptoms among 76% students [ 7 ]. In our study, the proportion of students showing symptoms of anxiety were 55.6%. A study by Sharma et al. revealed that more than half i.e. 56.9% of public high school students showed symptoms of anxiety [ 9 ]. Another study by Bhandari et. al, also found out that nearly one out of two students i.e., 46.5% suffered from anxiety [ 8 ].These findings are in line with the findings of our study. On contrary, a study by Bhandari reported that only 10% students had mild anxiety [ 7 ]. In our study, the prevalence of stress symptoms among students was 32.9%. A study by Sharma et. al reported that more than 1/4 th students i.e., 27.5% showed symptoms of stress which corroborates with the findings of our study.

While the prevalence of symptoms of DAS reported by our study corroborates with the existing literatures in Nepal, it is exceptionally high. One possible explanation for this could be that the data was collected at the beginning of academic session. The students in the eleventh grade were undergoing sudden transition from secondary school life to high school life with regards to new friends, teachers, school environment, and change in daily schedules whereas the students in 12 th grade were awaiting results of previous board exam. This anticipation and the tremendous pressure faced by 12 th grade students for tertiary education might have contributed to the high prevalence of symptoms of DAS among 12 th grade students whereas the higher prevalence of symptoms of DAS among 11 th grade students could be possibly explained by the inability to cope with the adjustment of sudden transition from secondary to high school life. Moreover, the wide range in prevalence of DAS symptoms among these community-based studies could be attributed to the difference in the setting (rural or urban) and difference in methodology used.

Among South Asian countries, the prevalence of depression reported by our study is in line with the studies conducted in India, and Bangladesh, but slightly higher than one conducted in China and [ 13 , 17 , 33 , 34 ]. On contrary, our study has shown higher prevalence of anxiety among students as compared to study conducted in India, Sri Lanka, Vietnam and China [ 12 , 19 , 22 , 34 ].The prevalence of symptoms of stress in this study is comparable to the study from Chandigarh but higher than similar study from Manipur, India [ 12 , 17 ]. Hence, it can be suggested that there is a huge burden of DAS among high school students in South Asia. In context of Nepal, there is no standalone mental health policy. Further, there is inadequate funding allocated for mental health services along with shortage of qualified mental health professionals. In addition, there is much stigma that surrounds mental illness which acts as a barrier to seek and utilize mental health care services [ 35 ]. Due to these reasons, mental health illnesses are likely to remain untreated and continue to persist in the society. This may explain the high prevalence of DAS in our setting.

Socio-demographic characteristics and association with symptoms of DAS (depression, anxiety and stress)

In current study, it was found that females were more likely to suffer from symptoms of anxiety and stress than their male counterparts. This finding corroborates with the findings from previous studies [ 19 , 21 , 36 – 39 ]. On the contrary, a study conducted in Dang, Nepal reported that males were 1.5 times more likely to become anxious [ 8 ].One possible explanation for this is adolescent stage in girls is marked by hormonal changes as a result of various reproductive events which may have a role in the etiology of anxiety disorders [ 40 ]. Furthermore, when compared to boys, girls are more likely to be subjected to stressful situations such as sexual and domestic violence, which may make them more prone to anxiety and stress problems [ 41 ].

This study revealed that the students who live in nuclear families were more likely to exhibit depressive symptoms compared to students from joint or extended families. There are more members in a joint family system, which may provide better opportunities for adolescents to share their emotions and issues, hence providing a strong support system that may serve as a protective factor against depression which may be lacking in nuclear families [ 42 ]. Moreover, this study also found out that risks of stress symptoms was higher among students who were staying far from their parents. A similar finding was reported by Arif et al., 2019 in Uttar Pradesh, India [ 43 ]. One of the possible explanations might be that students who live without their parents may spend a substantial amount of time alone after school, which does not encourage familial intimacy [ 44 ]. As a result, they may feel alone and disconnected from their parents [ 45 ]. These adolescents may miss out on the opportunity to internalize the support they would otherwise get, leading to increased stress.

In our study, the students who reported no formal mother’s education were at greater risk of showing symptoms of anxiety. This was in accordance with other similar studies [ 38 , 46 ]. The attachment theory provides a robust foundation for understanding how parental behavior affects a child’s ability to recognize and manage stressful events throughout their lives [ 47 ]. The theory supports that the educated mother plays a stronger parenting role in the development of emotional skills and mental health outcomes in teenagers which might be protective for anxiety.

Academic characteristics and association with symptoms of DAS

In our study, the students from science or humanities faculties were more likely to have depression and anxiety as compared to management students. This was in line with other studies which showed higher proportion of depressive symptoms among science students. [ 48 ]. Generally, science students have to compete more, study longer hours and have a higher level of curriculum difficulty than management students which explains the finding. Likewise, it is believed that the humanities students have a poorer past academic performance in the secondary school, and may have chosen this stream / faculty as a secondary choice [ 49 ]. This combined with the uncertainty regarding future work prospects among humanities students may likely explain the higher prevalence of depression among humanities students.

In our study, the students who reported to be stressed due to their studies were more likely to suffer from symptoms of DAS. Several studies have documented similar findings [ 7 , 22 ]. A possible explanation might be that high school is an important stage in an individual’s academic life. However, the inability to meet the expectation of parents, teachers, and oneself in terms of academic performance can lead to overburden of stress [ 50 ]. This persistent academic related stress might accelerate the development of mood disorders such as depression, anxiety and stress among the adolescents [ 51 ].

Contextual factors and association with symptoms of DAS

In our study, the risk of depressive symptoms was higher among those students who were bullied via electronic means. Literature suggests that higher the level of cyberbullying/electronic bullying leads to higher the level of depressive symptoms among adolescents [ 52 ]. A similar study by Perren et. al demonstrated that depression was significantly associated with cyberbullying even after controlling for traditional forms of bullying [ 20 ]. The victims of cyberbullying may experience anonymous verbal or visual threats via electronic means. These repeated incidents can cause the victims to feel powerless which exacerbates the feeling of fear. This can cause significant emotional distress among victims and contribute to development of depressive symptoms [ 53 ].

Even though widely utilized in both clinical as well as research setting, DASS scales are screening tools for symptoms of depression, anxiety, and stress. Hence, they cannot be used as a modality for diagnosis. This limitation should be considered when interpreting the findings of this study. Due to its cross-sectional design, this study was unable to establish causal relationship of depression, anxiety, and stress with associated factors. Since the study tools used in this study investigate the habits and activities of the high school students in the past, recall and reporting bias are likely; however, the effect due to potential confounders have been controlled. As Nepal is a culturally diverse country, the findings of only one municipality may not be generalized to the whole country. Therefore, future studies covering a larger population of high school students employing more robust study designs such as interventional studies are recommended to get the real scenario of common mental disorders.

In conclusion, more than half of the students had depression and anxiety symptoms and nearly one third of the students had stress symptoms. Nuclear family type, students from humanities/science faculty, presence of perceived academic stress, and being bullied electronically were found to be significantly associated with symptoms of depression. Female sex, no formal mother education, students from humanities/science faculty, and presence of perceived academic stress were significantly associated with symptoms of anxiety. Likewise, symptoms of stress were significantly associated with female sex, currently living without parents, and presence of perceived academic stress.

Therefore, prevention and control activities such as school-based counseling services focusing to reduce and manage academic stress and electronic bullying faced by the students are recommended considering findings of this research.

Supporting information

S1 file. questionnaire form used in data collection..

https://doi.org/10.1371/journal.pgph.0000516.s001

Acknowledgments

We are grateful to Tokha municipality for granting permission to conduct the study. Special thank goes to the school management and teachers for their co-ordination during data collection. Lastly, we would like to thank all the study participants for their co-operation and support during the study.

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• 9. Sharma P, Choulagai B. Stress, anxiety, and depression among adolescent students of public schools in Kathmandu. [cited 19 Mar 2022]. Available: www.jiom.com.np
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• 25. Brief Introduction | Tokha Municipality, Office Of the Municipal Executive. [cited 25 Jul 2021]. Available: https://www.tokhamun.gov.np/en/node/4
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Science News

Social media harms teens’ mental health, mounting evidence shows. what now.

Understanding what is going on in teens’ minds is necessary for targeted policy suggestions

Most teens use social media, often for hours on end. Some social scientists are confident that such use is harming their mental health. Now they want to pinpoint what explains the link.

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By Sujata Gupta

February 20, 2024 at 7:30 am

In January, Mark Zuckerberg, CEO of Facebook’s parent company Meta, appeared at a congressional hearing to answer questions about how social media potentially harms children. Zuckerberg opened by saying: “The existing body of scientific work has not shown a causal link between using social media and young people having worse mental health.”

But many social scientists would disagree with that statement. In recent years, studies have started to show a causal link between teen social media use and reduced well-being or mood disorders, chiefly depression and anxiety.

Ironically, one of the most cited studies into this link focused on Facebook.

Researchers delved into whether the platform’s introduction across college campuses in the mid 2000s increased symptoms associated with depression and anxiety. The answer was a clear yes , says MIT economist Alexey Makarin, a coauthor of the study, which appeared in the November 2022 American Economic Review . “There is still a lot to be explored,” Makarin says, but “[to say] there is no causal evidence that social media causes mental health issues, to that I definitely object.”

The concern, and the studies, come from statistics showing that social media use in teens ages 13 to 17 is now almost ubiquitous. Two-thirds of teens report using TikTok, and some 60 percent of teens report using Instagram or Snapchat, a 2022 survey found. (Only 30 percent said they used Facebook.) Another survey showed that girls, on average, allot roughly 3.4 hours per day to TikTok, Instagram and Facebook, compared with roughly 2.1 hours among boys. At the same time, more teens are showing signs of depression than ever, especially girls ( SN: 6/30/23 ).

As more studies show a strong link between these phenomena, some researchers are starting to shift their attention to possible mechanisms. Why does social media use seem to trigger mental health problems? Why are those effects unevenly distributed among different groups, such as girls or young adults? And can the positives of social media be teased out from the negatives to provide more targeted guidance to teens, their caregivers and policymakers?

“You can’t design good public policy if you don’t know why things are happening,” says Scott Cunningham, an economist at Baylor University in Waco, Texas.

Increasing rigor

Concerns over the effects of social media use in children have been circulating for years, resulting in a massive body of scientific literature. But those mostly correlational studies could not show if teen social media use was harming mental health or if teens with mental health problems were using more social media.

Moreover, the findings from such studies were often inconclusive, or the effects on mental health so small as to be inconsequential. In one study that received considerable media attention, psychologists Amy Orben and Andrew Przybylski combined data from three surveys to see if they could find a link between technology use, including social media, and reduced well-being. The duo gauged the well-being of over 355,000 teenagers by focusing on questions around depression, suicidal thinking and self-esteem.

Digital technology use was associated with a slight decrease in adolescent well-being , Orben, now of the University of Cambridge, and Przybylski, of the University of Oxford, reported in 2019 in Nature Human Behaviour . But the duo downplayed that finding, noting that researchers have observed similar drops in adolescent well-being associated with drinking milk, going to the movies or eating potatoes.

Holes have begun to appear in that narrative thanks to newer, more rigorous studies.

In one longitudinal study, researchers — including Orben and Przybylski — used survey data on social media use and well-being from over 17,400 teens and young adults to look at how individuals’ responses to a question gauging life satisfaction changed between 2011 and 2018. And they dug into how the responses varied by gender, age and time spent on social media.

Social media use was associated with a drop in well-being among teens during certain developmental periods, chiefly puberty and young adulthood, the team reported in 2022 in Nature Communications . That translated to lower well-being scores around ages 11 to 13 for girls and ages 14 to 15 for boys. Both groups also reported a drop in well-being around age 19. Moreover, among the older teens, the team found evidence for the Goldilocks Hypothesis: the idea that both too much and too little time spent on social media can harm mental health.

“There’s hardly any effect if you look over everybody. But if you look at specific age groups, at particularly what [Orben] calls ‘windows of sensitivity’ … you see these clear effects,” says L.J. Shrum, a consumer psychologist at HEC Paris who was not involved with this research. His review of studies related to teen social media use and mental health is forthcoming in the Journal of the Association for Consumer Research.

Cause and effect

That longitudinal study hints at causation, researchers say. But one of the clearest ways to pin down cause and effect is through natural or quasi-experiments. For these in-the-wild experiments, researchers must identify situations where the rollout of a societal “treatment” is staggered across space and time. They can then compare outcomes among members of the group who received the treatment to those still in the queue — the control group.

That was the approach Makarin and his team used in their study of Facebook. The researchers homed in on the staggered rollout of Facebook across 775 college campuses from 2004 to 2006. They combined that rollout data with student responses to the National College Health Assessment, a widely used survey of college students’ mental and physical health.

The team then sought to understand if those survey questions captured diagnosable mental health problems. Specifically, they had roughly 500 undergraduate students respond to questions both in the National College Health Assessment and in validated screening tools for depression and anxiety. They found that mental health scores on the assessment predicted scores on the screenings. That suggested that a drop in well-being on the college survey was a good proxy for a corresponding increase in diagnosable mental health disorders. 

Compared with campuses that had not yet gained access to Facebook, college campuses with Facebook experienced a 2 percentage point increase in the number of students who met the diagnostic criteria for anxiety or depression, the team found.

When it comes to showing a causal link between social media use in teens and worse mental health, “that study really is the crown jewel right now,” says Cunningham, who was not involved in that research.

A need for nuance

The social media landscape today is vastly different than the landscape of 20 years ago. Facebook is now optimized for maximum addiction, Shrum says, and other newer platforms, such as Snapchat, Instagram and TikTok, have since copied and built on those features. Paired with the ubiquity of social media in general, the negative effects on mental health may well be larger now.

Moreover, social media research tends to focus on young adults — an easier cohort to study than minors. That needs to change, Cunningham says. “Most of us are worried about our high school kids and younger.” 

And so, researchers must pivot accordingly. Crucially, simple comparisons of social media users and nonusers no longer make sense. As Orben and Przybylski’s 2022 work suggested, a teen not on social media might well feel worse than one who briefly logs on. 

Researchers must also dig into why, and under what circumstances, social media use can harm mental health, Cunningham says. Explanations for this link abound. For instance, social media is thought to crowd out other activities or increase people’s likelihood of comparing themselves unfavorably with others. But big data studies, with their reliance on existing surveys and statistical analyses, cannot address those deeper questions. “These kinds of papers, there’s nothing you can really ask … to find these plausible mechanisms,” Cunningham says.

One ongoing effort to understand social media use from this more nuanced vantage point is the SMART Schools project out of the University of Birmingham in England. Pedagogical expert Victoria Goodyear and her team are comparing mental and physical health outcomes among children who attend schools that have restricted cell phone use to those attending schools without such a policy. The researchers described the protocol of that study of 30 schools and over 1,000 students in the July BMJ Open.

Goodyear and colleagues are also combining that natural experiment with qualitative research. They met with 36 five-person focus groups each consisting of all students, all parents or all educators at six of those schools. The team hopes to learn how students use their phones during the day, how usage practices make students feel, and what the various parties think of restrictions on cell phone use during the school day.

Talking to teens and those in their orbit is the best way to get at the mechanisms by which social media influences well-being — for better or worse, Goodyear says. Moving beyond big data to this more personal approach, however, takes considerable time and effort. “Social media has increased in pace and momentum very, very quickly,” she says. “And research takes a long time to catch up with that process.”

Until that catch-up occurs, though, researchers cannot dole out much advice. “What guidance could we provide to young people, parents and schools to help maintain the positives of social media use?” Goodyear asks. “There’s not concrete evidence yet.”

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Countering a Student Mental Health Crisis in Overwhelmed Schools

As the counselor shortage continues, here are three ways a psychologist says schools can help prevent the escalation of student mental health issues..

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A 2023 study by Mental Health America noted while two million youths experienced depression, nearly 60% received no treatment. And while 75% of mental health issues are established before the age of 24, almost 90% of services and support available today are spent on acute care models.

The National Council for Behavioral Health reports more than three-quarters of all counties in the U.S. now face a severe shortage of behavioral health staffers, particularly in rural areas. Additionally, the current demand indicates a need for an additional 8,000 psychiatrists immediately, with projections indicating that this shortfall could double by 2025.

There’s a mental health crisis among young people, and schools can play a prominent role in supporting students.

Reduce stigma and talk openly about mental health

For superintendents and the educators, counselors, security and safety leaders they work alongside, a critical step forward is to help make student mental health part of an ongoing dialogue, not a reaction to an incident. The topic should also be socialized with educators across the school system. This will gain the perspective and feedback needed to build effective practices and policies, enabling overwhelmed schools to better support and help students.

A healthy dialogue should be opened with students as well. We must teach and encourage children to recognize and talk about feelings that cause them issues at home and school. This practice should be integrated into the school curriculum, alongside subjects such as healthy nutrition and sexual education, and addressed during events like assemblies. Recognizing and normalizing mental health as an integral aspect of overall health and fostering open discussion on this subject in schools is vital.

With a focus on building this open culture, students will be more apt to seek help for themselves or others who may be struggling. Consequently, schools will be better equipped to offer or facilitate access to the necessary support services.

Support a structure that helps involve everyone

• Mental health services : When students take that step to reach out, staff must be ready to deliver. That means connecting students with effective, on-premises mental health services spearheaded by school counselors. This is extremely important as students are more likely to participate in counseling at school than to seek out outside resources. In rural communities, it’s often their only option for getting treatment.
• Staff training : Ensure staff receive training on Mental Health First Aid (MHFA). Through this training, staff will develop the skills needed to recognize when youth are at potential risk and be able to intervene early.
• Discipline policies : When students feel their school is a safe place where rules are upheld and enforced fairly, discipline issues decrease. Review and monitor discipline policies and refine and update these as needed based on school trends data and feedback from students and parents.
• Staff mental health : It’s vital that superintendents ensure teachers and staff on the front lines receive mental health support to avoid burnout and personal stress. To this end, schools should explore wellness programs covering aspects from health education to emotional learning to stress management. This emphasis has been shown to raise job satisfaction and positively affect students and the environment.
• Parental involvement : Parents should be involved in mental health discussions and school leaders should be transparent when doing so. In conversations with parents, school officials should be as open as possible. Uninformed parents can hinder students from getting help, whereas those who are engaged can be the best facilitators.

Meet students where they are

The provider shortage and barriers noted above are standing in the way of students getting mental health services. To overcome this, they need to build skills and have easy access to tools that will enable them to manage their mental health.

According to a Gallup survey of 1,500 adolescents, you’ll find young people online — teens spend 4.8 hours per day using social media apps. With this in mind, an emerging approach to helping students build resilience to handle life’s challenges is web-based behavioral health applications that provide safe, clinically sound spaces for students to share experiences and gain support from empathetic peers and qualified professionals. Many of these platforms are available 24/7, and if there are any red flags indicating a student is in danger, escalation processes ensure services and adults outside the platform are engaged.

This offers hope to young people who otherwise wouldn’t know where to find mental health and wellness resources or if they’d benefit from them. These apps empower young people with education around such things as recognizing anxiety and how to manage it. In many ways, students are a sub-clinical population with issues that don’t necessarily rise to the levels of needing in-person therapy or medication. These apps can keep students from falling through the cracks and worsening what could be a preventable escalation of mental health issues.

Case in point

After only one year, a follow-up survey revealed the app’s potential. A few usage highlights included:

• 93% of students felt heard, understood, and respected
• 91% of students found online sessions helpful
• 86% would recommend the app to a friend

The app also won strong support from school leaders:

• 92% of school staff and district staff members felt such digital services can support students’ mental well-being in their districts
• 75% of principals and superintendents were “confident” or “very confident” it will improve the rapid escalation of support for students in crisis

This program could serve as a model for other states to adopt. When you provide this kind of access to evidence-based mental health support, students are provided with a resource right at their fingertips that provides education, increased awareness, coping skills, and strategies to better manage their mental health.

In doing so, overwhelmed schools and their leaders can mitigate a crisis and create sustainable, safe, and healthy environments.

Dr. Beth Pausic is a clinical psychologist and vice president of clinical excellence at Kooth Digital Health , a leader in youth-focused digital mental health.

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Living Better

The truth about teens, social media and the mental health crisis.

Michaeleen Doucleff

For years, the research picture on how social media affects teen mental health has been murky. That is changing as scientists find new tools to answer the question. Olivier Douliery /AFP via Getty Images hide caption

For years, the research picture on how social media affects teen mental health has been murky. That is changing as scientists find new tools to answer the question.

Back in 2017, psychologist Jean Twenge set off a firestorm in the field of psychology.

Twenge studies generational trends at San Diego State University. When she looked at mental health metrics for teenagers around 2012, what she saw shocked her. "In all my analyses of generational data — some reaching back to the 1930s — I had never seen anything like it," Twenge wrote in the Atlantic in 2017.

Twenge warned of a mental health crisis on the horizon. Rates of depression, anxiety and loneliness were rising. And she had a hypothesis for the cause: smartphones and all the social media that comes along with them. "Smartphones were used by the majority of Americans around 2012, and that's the same time loneliness increases. That's very suspicious," Twenge told NPR in 2017.

But many of her colleagues were skeptical. Some even accused her of inciting a panic with too little — and too weak — data to back her claims.

Now, six years later, Twenge is back. She has a new book out this week, called Generations , with much more data backing her hypothesis. At the same time, several high-quality studies have begun to answer critical questions, such as does social media cause teens to become depressed and is it a key contributor to a rise in depression?

In particular, studies from three different types of experiments, altogether, point in the same direction. "Indeed, I think the picture is getting more and more consistent," says economist Alexey Makarin , at the Massachusetts Institute of Technology.

Shots - Health News

How to help young people limit screen time — and feel better about how they look, a seismic change in how teens spend their time.

In Generations , Twenge analyzes mental health trends for five age groups, from the Silent Generation, who were born between 1925 and 1945, to Gen Z, who were born between 1995 and 2012. She shows definitively that "the way teens spend their time outside of school fundamentally changed in 2012," as Twenge writes in the book.

Take for instance, hanging out with friends, in person. Since 1976, the number of times per week teens go out with friends — and without their parents — held basically steady for nearly 30 years. In 2004, it slid a bit. Then in 2010, it nosedived.

"It was just like a Black Diamond ski slope straight down," Twenge tells NPR. "So these really big changes occur."

At the same time, around 2012, time on social media began to soar. In 2009, only about half of teens used social media every day, Twenge reports. In 2017, 85% used it daily. By 2022, 95% of teens said they use some social media, and about a third say they use it constantly, a poll from Pew Research Center found .

"Now, in the most recent data, 22% of 10th grade girls spend seven or more hours a day on social media," Twenge says, which means many teenage girls are doing little else than sleeping, going to school and engaging with social media.

Not surprisingly, all this screen time has cut into many kids' sleep time. Between 2010 and 2021, the percentage of 10th and 12th graders who slept seven or fewer hours each night rose from a third to nearly one-half. "That's a big jump," Twenge says. "Kids in that age group are supposed to sleep nine hours a night. So less than seven hours is a really serious problem."

Teen girls and LGBTQ+ youth plagued by violence and trauma, survey says

On its own, sleep deprivation can cause mental health issues. "Sleep is absolutely crucial for physical health and for mental health. Not getting enough sleep is a major risk factor for anxiety and depression and self-harm," she explains. Unfortunately, all of those mental health problems have continued to rise since Twenge first sounded the alarm six years ago.

"Nuclear bomb" on teen social life

"Every indicator of mental health and psychological well-being has become more negative among teens and young adults since 2012," Twenge writes in Generations . "The trends are stunning in their consistency, breadth and size."

Across the board, since 2010, anxiety, depression and loneliness have all increased . "And it's not just symptoms that rose, but also behaviors," she says, "including emergency room visits for self-harm, for suicide attempts and completed suicides." The data goes up through 2019, so it doesn't include changes due to COVID-19.

All these rapid changes coincide with what, Twenge says, may be the most rapid uptake in a new technology in human history: the incorporation of smartphones into our lives, which has allowed nearly nonstop engagement with social media apps. Apple introduced the first iPhones in 2007, and by 2012, about 50% of American adults owned a smartphone, the Pew Research Center found .

The timing is hard to ignore, says data scientist Chris Said , who has a Ph.D. in psychology from Princeton University and has worked at Facebook and Twitter. "Social media was like a nuclear bomb on teen social life," he says. "I don't think there's anything in recent memory, or even distant history, that has changed the way teens socialize as much as social media."

Murky picture becomes clearer on causes of teen depression

But the timing doesn't tell you whether social media actually causes depression in teens.

In the past decade, scientists have published a whole slew of studies trying to answer this question, and those studies sparked intense debate among scientists and in the media. But, Said says, what many people don't realize is scientists weren't using — or didn't even have — the proper tools to answer the question. "This is a very hard problem to study," he says. "The data they were analyzing couldn't really solve the problem."

Mental Health

The mental health of teen girls and lgbtq+ teens has worsened since 2011.

So the findings have been all over the place. They've been murky, noisy, inconclusive and confusing. "When you use tools that can't fully answer the question, you're going to get weak answers," he says. "So I think that's one reason why really strong evidence didn't show up in the data, at least early on."

On top of it, psychology has a bad track record in this field, Said points out. For nearly a century, psychologists have repeatedly blamed new technologies for mental and physical health problems of children, even when they've had little — or shady — data to back up their claims.

For example, in the 1940s, psychologists worried that children were becoming addicted to radio crime dramas, psychologist Amy Orben at the University of Cambridge explains in her doctoral thesis. After that, they raised concerns about comic books, television and — eventually — video games. Thus, many researchers worried that social media may simply be the newest scapegoat for children's mental health issues.

A handful of scientists, including MIT's Alexey Makarin, noticed this problem with the data, the tools and the field's past failures, and so they took the matter into their own hands. They went out and found better tools.

Hundreds of thousands of more college students depressed

Over the past few years, several high-quality studies have come that can directly test whether social media causes depression. Instead of being murky and mixed, they support each other and show clear effects of social media. "The body of literature seems to suggest that indeed, social media has negative effects on mental health, especially on young adults' mental health," says Makarin, who led what many scientists say is the best study on the topic to date.

In that study, Makarin and his team took advantage of a once-in-a-lifetime opportunity: the staggered introduction of Facebook across U.S. colleges from 2004 to 2006. Facebook rolled out into society first on college campuses, but not all campuses introduced Facebook at the same time.

For Makarin and his colleagues, this staggered rollout is experimental gold.

"It allowed us to compare students' mental health between colleges where Facebook just arrived to colleges where Facebook had not yet arrived," he says. They could also measure how students' mental health shifted on a particular campus when people started to spend a bunch of their time on social media.

Luckily, his team could track mental health at the time because college administrators were also conducting a national survey that asked students an array of questions about their mental health, including diagnoses, therapies and medications for depression, anxiety and eating disorders. "These are not just people's feelings," Makarin says. "These are actual conditions that people have to report."

They had data on a large number of students. "The data comes from more than 350,000 student responses across more than 300 colleges," Makarin says.

This type of study is called a quasi-experiment, and it allows scientists to estimate how much social media actually changes teens' mental health, or as Makarin says, "We can get causal estimates of the impact of Facebook on mental health."

So what happened? "Almost immediately after Facebook arrives on campus, we see an uptick in mental health issues that students report," Makarin says. "We especially find an impact on depression rates, anxiety disorders and other questions associated with depression in general."

And the effect isn't small, he says. Across the population, the rollout of Facebook caused about 2% of college students to become clinically depressed. That may sound modest, but with more than 17 million college students in the U.S. at the time, that means Facebook caused more than 300,000 young adults to suffer from depression.

For an individual, on average, engaging with Facebook decreases their mental health by roughly 22% of the effect of losing one's job, as reported by a previous meta-analysis, Makarin and his team found.

Facebook's rollout had a larger effect on women's mental health than on men's mental health, the study showed. But the difference was small, Makarin says.

He and his colleagues published their findings last November in the American Economic Review . "I love that paper," says economist Matthew Gentzkow at Stanford University, who was not involved in the research. "It's probably the most convincing study I've seen. I think it shows a clear effect, and it's really credible. They did a good job of isolating the effect of Facebook, which isn't easy."

Of course, the study has limitations, Gentzkow says. First off, it's Facebook, which teens are using less and less. And the version of Facebook is barebones. In 2006, the platform didn't have a "like" button" or a "newsfeed." This older version probably wasn't as "potent" as social media now, says data scientist Chris Said. Furthermore, students used the platform only on a computer because smartphones weren't available yet. And the study only examined mental health impacts over a six-month period.

Nevertheless, the findings in this study bolster other recent studies, including one that Gentzkow led.

Social media is "like the ocean" for kids

Back in 2018, Gentzkow and his team recruited about 2,700 Facebook users ages 18 or over. They paid about half of them to deactivate their Facebook accounts for four weeks. Then Gentzkow and his team looked to see how a Facebook break shifted their mental health. They reported their findings in March 2020 in the American Economic Review.

This type of study is called a randomized experiment, and it's thought of as the best way to estimate whether a variable in life causes a particular problem. But with social media, these randomized experiments have big limitations. For one, the experiments are short-term — here only four weeks. Also, people use social media in clusters, not as individuals. So having individuals quit Facebook won't capture the effect of having an entire social group quit together. Both of these limitations could underestimate the impact of social media on an individual and community.

Nevertheless, Gentzkow could see how deactivating Facebook made people, on average, feel better. "Being off Facebook was positive across well-being outcomes," he says. "You see higher happiness, life satisfaction, and also lower depression, lower anxiety, and maybe a little bit lower loneliness."

Gentzkow and his team measured participants' well-being by giving them a survey at the end of the experiment but also asking questions, via text message, through the experiment. "For example, we sent people text messages that say, 'Right now, would you say you're feeling happy or not happy,'" he explains.

Again, as with Makarin's experiment, the effect was moderate. Gentzkow and his colleagues estimate that temporarily quitting Facebook improves a person's mental health by about 30% of the positive effect seen by going to therapy. "You could view that meaning these effects are pretty big," he explains, "or you could also see that as meaning that the effects of therapy are somewhat small. And I think both of those things are true to an extent."

Scientists still don't know to what extent social media is behind the rising mental health issues among teenagers and whether it is the primary cause. "It seems to be the case — like it's a big factor," says MIT's Alexey Makarin, "but that's still up for debate."

Still, though, other specifics are beginning to crystallize. Scientists are narrowing in on what aspects of social media are most problematic. And they can see that social media won't hurt every teen — or hurt them by the same amount. The data suggests that the more hours a child devotes to social media, the higher their risk for mental health problems.

Finally, some adolescents are likely more vulnerable to social media, and children may be more vulnerable at particular ages. A study published in February 2022 looked to see how time spent on social media varies with life satisfaction during different times in a child's life (see the graphic).

The researchers also looked to see if a child's present use of social media predicted a decrease of life satisfaction one year later. That data suggests two windows of time when children are most sensitive to detrimental effects of social media, especially heavy use of it. For girls, one window occurs at ages 11 through 13. And for boys, one window occurs at ages 14 and 15. For both genders, there's a window of sensitivity around age 19 — or near the time teenagers enter college. Amy Orben and her team at the University of Cambridge reported the findings in Nature Communications .

This type of evidence is known as a correlative. "It's hard to draw conclusions from these studies," Gentzkow says, because many factors contribute to life satisfaction, such as environmental factors and family backgrounds. Plus, people may use social media because they're depressed (and so depression could be the cause, not the outcome of social media use).

"Nevertheless, these correlative studies, together with the evidence from the causal experiments, paint a picture that suggests we should take social media seriously and be concerned," Gentzkow adds.

Psychologist Orben once heard a metaphor that may help parents understand how to approach this new technology. Social media for children is a bit like the ocean, she says, noting that it can be an extremely dangerous place for children. Before parents let children swim in any open water, they make sure the child is well-prepared and equipped to handle problems that arise. They provide safety vests, swimming lessons, often in less dangerous waters, and even then parents provide a huge amount of supervision.

Alyson Hurt created the graphic. Jane Greenhalgh and Diane Webber edited the story.

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• mental health
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Students Think Social Media Is Fine, But Teachers See a Mental Health Minefield

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Many adults—from teachers to the U.S. surgeon general —will tell you that social media has the potential to dangerously erode K-12 students’ mental health.

School districts and lawmakers alike have responded to the growing chorus of concern. More than 200 districts (and counting) have sued major social media companies while lawmakers at the federal and state levels have been crafting legislation that would greatly curtail youth access to social media .

But there’s one constituency that policymakers, educators, and parents may not be listening to enough: students.

Nearly three quarters of high school students say that social media either has no impact or a positive impact on their mental health and well-being, according to a new EdWeek Research Center survey. Students who responded to the survey also point to many benefits arising from their social media use, such as making new friends, promoting creativity, and learning about other cultures and people.

The EdWeek Research Center surveyed a nationally representative sample of 1,056 high school students in February and March.

That doesn’t mean all teens are having a positive experience—29 percent of high schoolers said social media has a negative impact.

Explore the Survey Results

Whatever adults may think of how kids view social media, experts say it’s important to understand teens’ perspectives in order to teach students the social-emotional and digital- and media-literacy skills they need to use these platforms in a productive and healthy way.

“Often the question [adults are always asking] is, ‘What is technology doing to young people?’” said Ioana Literat, an associate professor at Columbia University, Teachers College, and the associate director of the school’s Media and Social Change Lab. “I like to ask, ‘What are young people doing with technology?’”

The answer: Teenagers say they are doing a lot. Forty-one percent said they have used social media to make new friends or build positive friendships, according to EdWeek’s survey. Around a quarter have used social media to develop a hobby, acquire knowledge or skills related to what they’re studying in school, and gain a better understanding of what they want to pursue after high school.

‘Peer connection or peer support on social media’

Teens also say they have connected with mentors and developed their communication and entrepreneurial skills through social media.

Nearly 1 in 3 high schoolers in the EdWeek survey said that social media has made them feel less alone.

Social media can especially be a lifeline for certain groups of students, said Chelsea Olson, a research scientist in the University of Wisconsin—Madison’s pediatrics department and a member of the university’s Social Media and Adolescent Health Research Team. LGBTQ+ youth, for example, are more likely to be bullied and struggle with depression and anxiety.

“And so, social media is a way that they can find community, they can connect with others, they can learn about themselves, they can seek resources online,” she said. “It could also be youth with chronic illnesses, especially illnesses that are rare or complicated. They might be able to go find others who are experiencing the same thing, getting that peer connection or peer support on social media, joining support groups, accessing information about their illness that they may not be able to find elsewhere.”

Even youth who are socially anxious can benefit from social media, Olson said, using it as a lower-stakes venue to practice social skills.

That’s not to say that teenagers’ social media experiences are all rosy. Nearly a quarter of high schoolers reported believing fake information they saw on social media and not getting enough sleep—the two most common answers when students were asked in the EdWeek Research Center survey about the negative consequences of their social media use.

Building a rapport with students to discuss the potential harm of social media

Understanding teens’ complicated relationship with social media is an important step to building a rapport with them that will allow educators to discuss the harm social media can cause, said Merve Lapus, the vice president of education outreach and engagement for Common Sense Media, a nonprofit research and advocacy organization that provides curricula and ratings on technology and media.

“The more we try to push our perspective without trying to take theirs into account, the more you build a rift between you as an educator and the students,” he said. “As a teacher, if I can’t try to authentically connect with how my kids are thinking, then there’s no way I’m going to be able to get them to connect to the way I’m thinking.”

And educators’ thoughts on the issue are decidedly more negative than teens’. The overwhelming majority of educators in a separate EdWeek Research Center survey said that social media has had a negative impact on students’ mental health and self-esteem. The nationally representative survey polled 595 teachers, school leaders, and district leaders and was conducted Dec. 2023 to Jan. 2024.

Ninety-one percent of educators said social media has had a negative impact on how students treat people in real life.

Educators are also far more concerned than teenagers about how the content that high schoolers post on social media today could jeopardize their future employment. Eight in 10 educators are very or somewhat concerned while only 4 in 10 teens are.

A quarter of educators indicated in the survey that they could not think of any positive outcomes their students experienced as a result of using social media, compared with 14 percent of students in the student survey.

“The biggest challenge here is that young people, especially those in middle and high school, need both autonomy and guidance,” said Heather Schwartz, a practice specialist at the Collaborative for Social Emotional Learning, or CASEL, in an email interview. “They are more expert in social media than many of their teachers, and they do not respond well when they feel they are being talked down to.”

‘It’s just another day in 8th grade’

The fact that educators see social media as such a threat to students’ mental health fits historical trends, said Columbia’s Literat.

“Whenever there is a communications technology that has a huge social impact, there is a tendency to panic. Often when we see these moral panics, the objects of the panic are young people and women,” she said, while acknowledging that the enormous scope of social media means that any negative impact from its use will be far reaching for all ages and genders.

All of this isn’t to say that educators’ opinions on how social media affects kids are wrong, said Lapus. Teens may not fully understand how social media might be impacting their mental health and well-being.

“In general, [teens] don’t have a comparison,” he said. “Educators, parents, you know a time of what school was like [before social media] when all the same dramas occurred, but they didn’t follow you home in the same capacity they do now. That has major effects on your mental health. We can see that, but for them, it’s just another day in 8th grade.”

Where there is more agreement among educators and students on the issue of social media and mental health and well-being is educators’ roles in helping students learn to navigate the challenges. Majorities of both groups—65 percent of educators and 75 percent of students—think that teachers should be responsible for helping students learn how to use social media in ways that will support students’ mental health and well-being.

But only a little more than half the students reported in the survey that a teacher has ever discussed the topic with them.

One simple step to make things better

One simple step that educators—and all adults—can take to help promote healthier social media habits among the young people they interact with is to model good behavior, experts say. That means showing respect to others on social media, not using their cellphones during class, and not posting photos or information about students without their permission (or their parents’ permission).

But to really help students reap the benefits of social media while minimizing the harm, schools need to teach digital-literacy skills—such as understanding the addictive design features of social media—paired with social-emotional skills such as self-regulation, self-awareness, empathy, and relationship-building skills.

“Self-awareness includes understanding our own identities,” Schwartz said in an email interview. “Self-management includes agency, or a sense that what we do makes a difference. This also means understanding when something is getting under their skin, and pausing before responding.”

Just as students’ views on social media are nuanced, so, too, should educators’ approaches to discussing the platforms that have become an indispensable venue for teens’ communication, socialization, and identity-formation, experts emphasize.

For example, while it’s important for schools to teach social-emotional skills, educators should acknowledge that it’s not always easy for students to apply them in real life. Social media often creates a tension with the explicit SEL skills schools are teaching, said Emily Weinstein, the executive director of the Center for Digital Thriving at Harvard University.

“It gets complicated when kids want to disconnect, but they have a friend who needs to talk: Their self-regulation and need for sleep, if it’s late at night, is pitted against their empathy,” said Weinstein. “It can be hard to figure this out in a world where you’re connected 24/7.”

The message educators should be driving home, said Lapus of Common Sense Media, is this: Yes, social media can be a positive force in students’ lives. But these platforms are also designed to override many of the social-emotional skills that help students protect their well-being, he said.

For instance, social media features such as the “like” button make it hard for users to exercise self-control, said Lapus, because they’re designed to keep users engaged on the app. “You see the number of likes and see people commenting, the impulse to not feel left out is real, and the ease of responding is built in by design.”

Teachers, he said, should encourage students to examine what’s important to them and how social media can help support those values. (For example, if family is important to a student, social media can help them stay connected with relatives who live far away.)

The goal, Lapus said, is to help students identify when social media isn’t serving their interests. “It’s up to you to be able to continue the cycle that’s helpful or break the cycle because it’s not giving you what you hope to get out of it,” he said.

Data analysis for this article was provided by the EdWeek Research Center. Learn more about the center’s work.

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Study Tracks Shifts in Student Mental Health During College

Dartmouth study followed 200 students all four years, including through the pandemic.

Phone App Uses AI to Detect Depression From Facial Cues

A four-year study by Dartmouth researchers captures the most in-depth data yet on how college students’ self-esteem and mental health fluctuates during their four years in academia, identifying key populations and stressors that the researchers say administrators could target to improve student well-being. 

The study also provides among the first real-time accounts of how the coronavirus pandemic affected students’ behavior and mental health. The stress and uncertainty of COVID-19 resulted in long-lasting behavioral changes that persisted as a “new normal” even as the pandemic diminished, including students feeling more stressed, less socially engaged, and sleeping more.

The researchers tracked more than 200 Dartmouth undergraduates in the classes of 2021 and 2022 for all four years of college. Students volunteered to let a specially developed app called StudentLife tap into the sensors that are built into smartphones. The app cataloged their daily physical and social activity, how long they slept, their location and travel, the time they spent on their phone, and how often they listened to music or watched videos. Students also filled out weekly behavioral surveys, and selected students gave post-study interviews. 

The study—which is the longest mobile-sensing study ever conducted—is published in the Proceedings of the ACM on Interactive, Mobile, Wearable and Ubiquitous Technologies .

The researchers will present it at the Association of Computing Machinery’s UbiComp/ISWC 2024 conference in Melbourne, Australia, in October. 

These sorts of tools will have a tremendous impact on projecting forward and developing much more data-driven ways to intervene and respond exactly when students need it most.

The team made their anonymized data set publicly available —including self-reports, surveys, and phone-sensing and brain-imaging data—to help advance research into the mental health of students during their college years. 

Andrew Campbell , the paper’s senior author and Dartmouth’s Albert Bradley 1915 Third Century Professor of Computer Science, says that the study’s extensive data reinforces the importance of college and university administrators across the country being more attuned to how and when students’ mental well-being changes during the school year.

“For the first time, we’ve produced granular data about the ebb and flow of student mental health. It’s incredibly dynamic—there’s nothing that’s steady state through the term, let alone through the year,” he says. “These sorts of tools will have a tremendous impact on projecting forward and developing much more data-driven ways to intervene and respond exactly when students need it most.”

First-year and female students are especially at risk for high anxiety and low self-esteem, the study finds. Among first-year students, self-esteem dropped to its lowest point in the first weeks of their transition from high school to college but rose steadily every semester until it was about 10% higher by graduation.

“We can see that students came out of high school with a certain level of self-esteem that dropped off to the lowest point of the four years. Some said they started to experience ‘imposter syndrome’ from being around other high-performing students,” Campbell says. “As the years progress, though, we can draw a straight line from low to high as their self-esteem improves. I think we would see a similar trend class over class. To me, that’s a very positive thing.”

Female students—who made up 60% of study participants—experienced on average 5% greater stress levels and 10% lower self-esteem than male students. More significantly, the data show that female students tended to be less active, with male students walking 37% more often.

Sophomores were 40% more socially active compared to their first year, the researchers report. But these students also reported feeling 13% more stressed during their second year than during their first year as their workload increased, they felt pressure to socialize, or as first-year social groups dispersed.

One student in a sorority recalled that having pre-arranged activities “kind of adds stress as I feel like I should be having fun because everyone tells me that it is fun.” Another student noted that after the first year, “students have more access to the whole campus and that is when you start feeling excluded from things.” 

In a novel finding, the researchers identify an “anticipatory stress spike” of 17% experienced in the last two weeks of summer break. While still lower than mid-academic year stress, the spike was consistent across different summers.

In post-study interviews, some students pointed to returning to campus early for team sports as a source of stress. Others specified reconnecting with family and high school friends during their first summer home, saying they felt “a sense of leaving behind the comfort and familiarity of these long-standing friendships” as the break ended, the researchers report. 

“This is a foundational study,” says Subigya Nepal , first author of the study and a PhD candidate in Campbell’s research group. “It has more real-time granular data than anything we or anyone else has provided before. We don’t know yet how it will translate to campuses nationwide, but it can be a template for getting the conversation going.”

The depth and accuracy of the study data suggest that mobile-sensing software could eventually give universities the ability to create proactive mental-health policies specific to certain student populations and times of year, Campbell says.

For example, a paper Campbell’s research group published in 2022 based on StudentLife data showed that first-generation students experienced lower self-esteem and higher levels of depression than other students throughout their four years of college.

“We will be able to look at campus in much more nuanced ways than waiting for the results of an annual mental health study and then developing policy,” Campbell says. “We know that Dartmouth is a small and very tight-knit campus community. But if we applied these same methods to a college with similar attributes, I believe we would find very similar trends.”

Weathering the pandemic

When students returned home at the start of the coronavirus pandemic, the researchers found that self-esteem actually increased during the pandemic by 5% overall and by another 6% afterward when life returned closer to what it was before. One student suggested in their interview that getting older came with more confidence. Others indicated that being home led to them spending more time with friends talking on the phone, on social media, or streaming movies together. 

The data show that phone usage—measured by the duration a phone was unlocked—indeed increased by nearly 33 minutes, or 19%, during the pandemic, while time spent in physical activity dropped by 52 minutes, or 27%. By 2022, phone usage fell from its pandemic peak to just above pre-pandemic levels, while engagement in physical activity had recovered to exceed the pre-pandemic period by three minutes. 

Despite reporting higher self-esteem, students’ feelings of stress increased by more than 10% during the pandemic. By the end of the study in June 2022, stress had fallen by less than 2% of its pandemic peak, indicating that the experience had a lasting impact on student well-being, the researchers report. 

In early 2021, as students returned to campus, their reunion with friends and community was tempered by an overwhelming concern about the still-rampant coronavirus. “There was the first outbreak in winter 2021 and that was terrifying,” one student recalls. Another student adds: “You could be put into isolation for a long time even if you did not have COVID. Everyone was afraid to contact-trace anyone else in case they got mad at each other.”

Female students were especially concerned about the coronavirus, on average 13% more than male students. “Even though the girls might have been hanging out with each other more, they are more aware of the impact,” one female student reported. “I actually had COVID and exposed some friends of mine. All the girls that I told tested as they were worried. They were continually checking up to make sure that they did not have it and take it home to their family.”

Students still learning remotely had social levels 16% higher than students on campus, who engaged in activity an average of 10% less often than when they were learning from home. However, on-campus students used their phones 47% more often. When interviewed after the study, these students reported spending extended periods of time video-calling or streaming movies with friends and family.

Social activity and engagement had not yet returned to pre-pandemic levels by the end of the study in June 2022, recovering by a little less than 3% after a nearly 10% drop during the pandemic. Similarly, the pandemic correlates with students sticking closer to home, with their distance traveled nearly cut in half during the pandemic and holding at that level since then.

Campbell and several of his fellow researchers are now developing a smartphone app known as MoodCapture that uses artificial intelligence paired with facial-image processing software to reliably detect the onset of depression before the user even knows something is wrong.

Morgan Kelly can be reached at [email protected] .

• Mental Health and Wellness
• Innovation and Impact
• Arts and Sciences
• Class of 2021
• Class of 2022
• Department of Computer Science
• Guarini School of Graduate and Advanced Studies
• Mental Health

A Q&A With Film Critic and Theorist Vinzenz Hediger

After a Year of Turmoil, Harvard’s Applications Drop

Mental Health

Poor Mental Health Impacts Adolescent Well-being

Key Takeaways

• The number of adolescents reporting poor mental health is increasing.
• Building strong bonds and connecting to youth can protect their mental health.
• Schools and parents can create protective relationships with students and help them grow into healthy adulthood.

Promoting Mental Health and Well-Being in Schools: An Action Guide for School Administrators and Leaders

Learn about school-based strategies and approaches to support student mental health.

Adolescent Mental Health Continues to Worsen

CDC’s Youth Risk Behavior Surveillance Data Summary & Trends Report: 2011-2021 [PDF – 10 MB]  highlights concerning trends about the mental health of U.S. high school students.

• In 2021, more than 4 in 10 (42%) students felt persistently sad or hopeless and nearly one-third (29%) experienced poor mental health.
• In 2021, more than 1 in 5 (22%) students seriously considered attempting suicide and 1 in 10 (10%) attempted suicide.

These data bring into focus the level of distress many students are experiencing.

Some groups are more affected than others.

These feelings were found to be more common among LGBQ+ students, female students, and students across racial and ethnic groups.

• Nearly half (45%) of LGBQ+ students in 2021 seriously considered attempting suicide—far more than heterosexual students.
• Black students were more likely to attempt suicide than students of other races and ethnicities.

Why Is This a Big Deal?

Poor mental health in adolescence is more than feeling blue. It can impact many areas of a teen’s life. Youth with poor mental health may struggle with school and grades , decision making, and their health.

Mental health problems in youth often go hand-in-hand with other health and behavioral risks like increased risk of drug use , experiencing violence, and higher risk sexual behaviors  that can lead to HIV, STDs, and unintended pregnancy.

Because many health behaviors and habits are established in adolescence that will carry over into adult years, it is very important to help youth develop good mental health.

Need Support Now?

• Call or text 988
• Chat with Lifeline

The Good News

The good news is that teens are resilient, and we know what works to support their mental health:  feeling  connected  to school and family .

• Fortunately, the same prevention strategies that promote mental health—like helping students feel connected to school/family—help prevent a range of negative experiences, like drug use and violence.
• Building strong bonds and relationships with adults and friends at school, at home and in the community provides youth with a sense of connectedness.
• This feeling of connectedness is important and can protect adolescents from poor mental health, and other risks like drug use and violence.
• Youth need to know someone cares about them. Connections can be made virtually or in person.

There is a Role for Everyone in Supporting Teen Mental Health

As we’ve learned nationally during the COVID-19 pandemic , schools are critical in our communities to supporting children and families. While the expectation is that schools provide education, they also provide opportunities for youth to engage in physical activity and academic, social, mental health, and physical health services, all of which can relieve stress and help protect against negative outcomes.

However, the pandemic disrupted many school-based services, increasing the burden on parents, increasing stress on families, and potentially affecting long-term health outcomes for parents and children alike, especially among families already at risk for negative health outcomes from social and environmental factors.

Support is needed to mitigate these negative outcomes and lessen educational and health disparities.

Critical supports and services need to be comprehensive and community wide and should include:

What schools can do:.

• Help students cope with emergencies and their aftermath.
• Linking students to mental health services.
• Integrating social emotional learning.
• Training staff.
• Supporting staff mental health.
• Reviewing discipline policies to ensure equity.
• Building safe and supportive environments.

What parents and families can do:

• Communicate openly and honestly, including about their values.
• Supervise their adolescent to facilitate healthy decision-making.
• Spend time with their adolescent enjoying shared activities.
• Become engaged in school activities and help with homework.
• Volunteer at their adolescent’s school.
• Communicate regularly with teachers and administrators.

What healthcare providers can do:

• Ask adolescents about family relationships and school experiences as a part of routine health screenings.
• Encourage positive parenting practices .
• Engage parents in discussions about how to connect with their adolescents, communicate effectively, and monitor activities and health behaviors.
• Educate parents and youth about adolescent development and health risks.

More Information

Parents and families may find the following resources helpful to support the mental and emotional well-being of their adolescents:

• CDC Children’s Mental Health
• CDC Mental Health
• School Connectedness
• Teen Mental Health
• Resources for Coping After Emergencies
• School-Based Physical Activity Improves the Social and Emotional Climate for Learning
• School Nutrition and the Social and Emotional Climate and Learning

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Q&A: How Can Schools Help Students After a Mental Health ER Visit?

March 28, 2024 • By Audrey Breen, [email protected] Audrey Breen, [email protected]

• Audrey Breen , [email protected]

Research shows schools often have plans to support students after an inpatient hospital stay for psychiatric treatment, but there’s little knowledge in how they support students after an emergency department visit. (Image generated by John DiJulio, University Communications, assisted by AI)

K-12 students experiencing a mental health crisis often are referred to a hospital emergency department – and then face returning to school the next day.

Unfortunately, research by Lora Henderson Smith, an assistant professor in the University of Virginia’s School of Education and Human Development and licensed clinical psychologist, found that very little is known about how best to support these students when they do return.

Smith’s research found schools often have plans to support students returning to school after an inpatient hospital stay for psychiatric treatment. But she found a huge knowledge gap in the ways students are supported after an emergency department visit.

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What’s Wrong With the Kids?

“I stumbled upon the literature on the number of kids who go to the emergency department for mental health-related issues, but aren’t actually hospitalized,” said Smith, a faculty affiliate with UVA’s Youth-Nex research center. “And that was eye-opening because I realized that although there is little, but growing research on hospital-to-school transitions, there’s virtually nothing on emergency department-to-school transitions.”

As an iTHRIV scholar, and backed by a grant from the 4-VA organization, Smith is researching how best to support students returning to school after an emergency department visit, in partnership with UVA School of Medicine colleagues Dr. Moira Smith and Genevieve Lyons. 

We sat down with Lora Smith to better understand the issue and how to fill the gap.

Q. How many students seeking mental health care in the emergency department are admitted versus discharged the same day?

A. A majority of kids who go to the emergency department for a mental health issue will be discharged without being admitted to the hospital. The numbers vary, depending on the study and the region, including what resources are available. In some cases, as few as 8% of kids who go to the emergency department will be admitted.

About 30% to 40% of kids seen in the emergency department are referred from school. Obviously, they’re being referred because their needs are beyond what the school can do in a particular moment. And then, in many cases, that child returns to school the next day, because they were not admitted.

Q. How does that affect school mental health professionals?

A. A lot of school mental health professionals don’t receive formal training in how to best support kids returning to school after a mental health crisis. But a lot of them are amazing at it because they learn on the job and learn from peers. 

Most of the folks that we interviewed shared that their schools have some type of protocol, whether formal or informal, for a hospital-to-school transition. But they weren’t thinking about emergency department-to-school transition in the same way. Even though not enough has been done for hospital-to-school transition, there’s even less being done for emergency department-to-school transition.

Q. What keeps students from getting the support they need when they return to school?

A. One barrier is a gap in services across the full continuum of care for youth with mental health concerns. Schools and emergency departments don’t often have the same definition of “imminent risks.” School mental health professionals tend to have a lower tolerance threshold, meaning school policies and procedures might require a child who is in need of mental health services to be sent to the emergency department. But according to the emergency department, the same student may not meet the threshold for the level of care provided at the hospital.

Lora Henderson Smith, an assistant professor in UVA’s School of Education and Human Development and licensed clinical psychologist, found little is known about how best to support these students when they return to school. (Contributed photo)

Another is a gap in communication. There are privacy concerns and issues with (federal privacy laws like) HIPAA and FERPA. So, if a family doesn’t tell the school that they went to the hospital, then there’s no way for the school to know under most circumstances. 

Some families may not trust the school, and for others, there is a stigma around needing mental health care. So that really speaks to the need for trust- and relationship-building between schools and families. 

Q. As a clinical and school psychologist, what kind of support do you hope students receive?

A. There is something called an “interconnected systems framework,” and in this case that would integrate community and mental health resources with what is available in schools. Utilizing a framework like that could create stronger working relationships and partnerships between schools, health systems and other community providers and resources. Ideally, adults could proactively support kids with mental health issues across the continuum of care by providing needed outpatient care to hopefully prevent emergency department visits and hospitalizations. That takes lots of planning and collaboration, thinking well beyond an individual child in the emergency department.

More immediately, schools could begin to implement a school reentry meeting to discuss not just the emergency department visit, but what else has been going on and how the school can be most helpful in helping that child meet their academic, social-emotional and mental health needs. There also needs to be ongoing follow-up and progress monitoring, to make sure that that child’s needs are being met beyond just the school re-entry meeting. 

Something that I really want to highlight is how we can integrate other adults in the schools to help support kids. Teachers and administrators, and school mental health professionals, are being pulled in so many different directions. There are other people in the school building – a secretary or custodian – who could also support students’ overall well-being. With the appropriate confidentiality and privacy measures in place, I’d love to get them looped in and to have them on the team as well.

Even a high-five or “It’s good to see you today!” can brighten the day of a child who’s returning to school. Any adult in the school building can do that.

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Audrey Breen

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[email protected] 434-924-0809

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April 1, 2024

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Finding mental health support for student-athletes after sports

E AST LANSING, Mich. (WILX) - Sports are a significant part of a student athlete’s identity as they live and breathe the game. When any athlete experiences a career-ending injury or graduates from school, studies find that they tend to struggle with their mental health.

That was the case for Michigan State senior Lia Moore.

“I was known for volleyball; my whole world was volleyball.”

She began her career on the court in middle school.

“My friend that I should come out and play for club volleyball and travel volleyball, but my mom didn’t know if I was serious about it, but then she took me to tryouts, and the coaches there wanted me to play really bad,” Moore explained. “I had a lot of natural talent, and then they added skill on top of that, and I thought, ‘Okay, this is my thing.”

It really did become ‘her thing’ as she practiced every day.

“All of my weekends were gone; it was volleyball 24/7.”

Her skills caught the eyes of universities across the country, and she committed to MSU as an 8th grader.

“The pressure was really high for me. I mean, everybody had high expectations,” remembered Moore.

That pressure to perform continued to increase once she officially became a Spartan athlete in 2020.

“You can’t just go into the game and just play; you have to the other team’s tendencies so that you can beat them so that you’re not caught off guard by anything.”

However, as Moore continued to work harder and harder, she was completely caught off guard by a heart complication.

“I was working out, and I started to notice that my heart was beating really, really fast, and I couldn’t breathe. I couldn’t really catch my breath. I was starting to black out a little bit, and it was starting to happen more frequently.”

After heart monitoring and town surgeries, Moore heard the devastating news that she could no longer play volleyball.

“It kind of feels like my whole world came crashing down.”

Although the team and coaches still surrounded and supported her, Moore says that she felt a shift in her mental health.

“I just felt like an outsider looking in,” explained Moore. “I was just a little distant. I didn’t really open up much to people about how I was doing because I’m the type of person I’m gonna be acting like I was okay even though I wasn’t.”

Both Shayna Bruno and Doron Willis, associate directors of the Student-Athlete Wellness Center, say that these feelings of grief, loss, anxiety, and depression tend to follow a major life change.

“Once they stop playing sports, a lot of mental health issues tend to happen because a lot of your identity and who you are gets wrapped up into your sport, and then you’re left with an existential crisis of like who am I without this sport in my life?” said Bruno. “A lot of people find themselves lost in so many ways, and then from there can just have a huge impact on day-to-day functioning.”

To help athletes find their way, the MSU Student Wellness Center keeps its doors open for current athletes and now alumni through its new State of Mind Program. This innovative program offers mental health assistance to all alumni student-athletes and their families through a dedicated 24/7 call line, preferred access to select clinical programs, and a nationwide network of providers.

Key Features of the Alumni STATE of Mind Program include:

·  Dedicated Concierge Call Line:  A 24/7 dedicated concierge call line, reachable at (855) 2-SPARTY, (855-277-2789), providing personalized assistance and immediate crisis support. Non-crisis communication is also available at  [email protected]

·  Preferred Access to Clinical Programs:  Alumni and their families will have preferred access to select clinical programs tailored to meet their specific mental health needs.

·  Nationwide Network of Providers:  The program grants access to a nationwide list of vetted and accredited mental health providers, ensuring MSU alumni have a broad range of options for receiving quality care.

·  Discounted Provider Pricing:  Participants in the program benefit from discounted pricing on mental health services, ensuring affordability and accessibility for all.

“We’re here to make you the best version of yourself possible. Start identifying other aspects of yourself that can bring you just as much success as sports can because oftentimes we don’t realize that we often have these other intangible skills because we’re so programmed to believe that our physical attributes mean more,” said Willis. “So the sooner you talk about it, the better you get in to identify these skills, and you’re pretty much setting yourself up for success beyond athletics.”

Lia found her skills in cooking after she could no longer play sports. She now hosts The Green Cuisine, a vegan cooking show.

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Mental Health, Suicidality, and Connectedness Among High School Students During the COVID-19 Pandemic — Adolescent Behaviors and Experiences Survey, United States, January–June 2021

Sherry everett jones, kathleen a. ethier, marci hertz, sarah degue, vi donna le, jemekia thornton, patricia j dittus, sindhura geda.

Disruptions and consequences related to the COVID-19 pandemic, including school closures, social isolation, family economic hardship, family loss or illness, and reduced access to health care, raise concerns about their effects on the mental health and well-being of youths. This report uses data from the 2021 Adolescent Behaviors and Experiences Survey, an online survey of a probability-based, nationally representative sample of U.S. public- and private-school students in grades 9–12 (N = 7,705), to assess U.S. high school students’ mental health and suicidality during the COVID-19 pandemic. The study also examines whether mental health and suicidality are associated with feeling close to persons at school and being virtually connected to others during the pandemic. Overall, 37.1% of students experienced poor mental health during the pandemic, and 31.1% experienced poor mental health during the preceding 30 days. In addition, during the 12 months before the survey, 44.2% experienced persistent feelings of sadness or hopelessness, 19.9% had seriously considered attempting suicide, and 9.0% had attempted suicide. Compared with those who did not feel close to persons at school, students who felt close to persons at school had a significantly lower prevalence of poor mental health during the pandemic (28.4% versus 45.2%) and during the past 30 days (23.5% versus 37.8%), persistent feelings of sadness or hopelessness (35.4% versus 52.9%), having seriously considered attempting suicide (14.0% versus 25.6%), and having attempted suicide (5.8% versus 11.9%). The same pattern was observed among students who were virtually connected to others during the pandemic (i.e., with family, friends, or other groups by using a computer, telephone, or other device) versus those who were not. Comprehensive strategies that improve feelings of connectedness with others in the family, in the community, and at school might foster improved mental health among youths during and after the COVID-19 pandemic.

Introduction

Emerging data suggest that the COVID-19 pandemic has negatively affected the mental health of many children and adolescents ( 1 ). Before the pandemic, youth mental health was already an important public health concern ( 2 , 3 ). For example, among high school students nationwide, significant increases occurred between 2009 and 2019 in having persistent feelings of sadness or hopelessness (26.1% to 36.7%), having seriously considered attempting suicide (13.8% to 18.8%), and having attempted suicide (6.3% to 8.9%) ( 2 ). For many youths during the pandemic, mental health was affected by school closures, social isolation, family economic hardship, fear of family loss or illness, and reduced access to health care because of inadequate insurance coverage or medical office closures and reduced hours ( 1 ). Two longitudinal studies on adolescent mental health during the pandemic found increases in depression and anxiety over the course of the pandemic ( 4 , 5 ). In one study, these symptoms were predicted by COVID-19–related worries, online learning difficulties, and increased conflict with parents ( 4 ). In another study, emergency department visits for suspected suicide were 50.6% higher among girls and 3.7% higher among boys from February through March 2021 than during the same period in 2019 ( 6 ). To understand the impact of COVID-19 on youth mental health and to identify potential protective factors, this study examines U.S. high school students’ mental health and suicidality during the COVID-19 pandemic, including the relation between mental health and connectedness to school, family, friends, and community groups. Public health and health care professionals, communities, schools, families, and adolescents can use these findings to better understand students’ mental health and suicidal thoughts and attempts during the pandemic and how fostering connectedness at school and with others could be one strategy to promote adolescent health and well-being during the pandemic and beyond.

Data Source

This report includes data from the Adolescent Behaviors and Experiences Survey (ABES), which was conducted by CDC during January–June 2021 to assess student behaviors and experiences during the COVID-19 pandemic. ABES was a one-time, probability-based online survey of U.S. high school students. ABES used a stratified, three-stage cluster sampling approach to obtain a nationally representative sample of public- and private-school students in grades 9–12 in the 50 U.S. states and the District of Columbia (N = 7,705). Participation in ABES was voluntary; each school and teacher decided whether students completed the survey during instructional time or on their own time. Additional information about ABES sampling, data collection, response rates, and processing is available in the overview report of this supplement ( 7 ). The ABES questionnaire, datasets, and documentation are available at https://www.cdc.gov/healthyyouth/data/abes.htm .

This analysis included seven measures: 1) poor mental health during the pandemic, 2) poor mental health during the past 30 days, 3) persistent feelings of sadness or hopelessness during the past 12 months, 4) serious consideration of attempting suicide during the past year, 5) attempted suicide during the past year, 6) feeling close to persons at school (time frame not specified), and 7) being virtually connected to others during the pandemic ( Table 1 ). For the pandemic-related questions, the time frame was not further specified. In addition, the following demographic characteristics were analyzed: sex, sexual identity (heterosexual; gay, lesbian, or bisexual; or other or questioning), and race and ethnicity (non-Hispanic American Indian or Alaska Native [AI/AN], non-Hispanic Asian [Asian], non-Hispanic Black [Black], Hispanic or Latino [Hispanic], non-Hispanic persons of multiple races [multiracial], non-Hispanic Native Hawaiian or other Pacific Islander, and non-Hispanic White [White]).

Weighted prevalence estimates and 95% CIs were calculated for all study variables among students overall and by demographic characteristics. Statistically significant pairwise differences for the study variables by demographic characteristics, and for associations between mental health, suicidality, and connectedness, were determined by t -tests for proportions. Analyses were completed using SUDAAN (version 11.0.3; RTI International) to account for the complex survey design and weighting. Differences were considered statistically significant if the p value was <0.05. Only significant results are presented in the text.

Poor Mental Health

Approximately one in three high school students experienced poor mental health (most of the time or always) during the COVID-19 pandemic (37.1%) and during the past 30 days (31.1%) ( Table 2 ). During the 12 months before the survey, 44.2% experienced persistent feelings of sadness or hopelessness; that is, had ever felt so sad or hopeless almost every day for two weeks or more in a row that they stopped doing some usual activities.

Abbreviations: AI/AN = American Indian or Alaska Native; NH/OPI = Native Hawaiian or other Pacific Islander.

* Refer to Table 1 for variable definitions.

† All percentages are weighted.

§ Significantly different from male students, based on t -test analysis (p<0.05).

¶ Significantly different from Hispanic students, based on t -test analysis (p<0.05).

** Significantly different from non-Hispanic multiracial students, based on t -test analysis (p<0.05).

†† Significantly different from non-Hispanic White students, based on t -test analysis (p<0.05).

§§ Results suppressed because n<30.

¶¶ Significantly different from non-Hispanic Asian students, based on t -test analysis (p<0.05).

*** Significantly different from non-Hispanic Black students, based on t -test analysis (p<0.05).

††† Significantly different from heterosexual students, based on t -test analysis (p<0.05).

§§§ Significantly different from other or questioning students based on t -test analysis (p<0.05).

The prevalence of poor mental health during the pandemic, poor mental health during the past 30 days and persistent feelings of sadness or hopelessness were higher among female than male students ( Table 2 ). Although differences by race and ethnicity were detected for each of these three variables, no consistent patterns were found. The prevalence of poor mental health during the pandemic was higher among gay, lesbian, or bisexual students and other or questioning students than among heterosexual students. The prevalence of poor mental health during the past 30 days and of persistent feelings of sadness or hopelessness was highest among gay, lesbian, or bisexual students, followed by other or questioning students. Heterosexual students had the lowest prevalence.

Suicidal Thoughts and Behaviors

During the 12 months before the survey, 19.9% of students had seriously considered attempting suicide, and 9.0% had attempted suicide. The prevalence of having seriously considered attempting suicide and attempting suicide was higher among female students than male students and varied by race and ethnicity. The prevalence of having seriously considered attempting suicide was higher among White students than Black or Asian students and higher among multiracial students than Black students. The prevalence of having attempted suicide was higher among AI/AN students than White, Black, Hispanic, or Asian students. The prevalence of having seriously considered attempting suicide and attempted suicide was highest among gay, lesbian, or bisexual students, followed by other or questioning students. Heterosexual students had the lowest prevalence.

Connectedness

At the time of the survey, 46.6% of students strongly agreed or agreed that they felt close to persons at school. In contrast, 71.8% of students sometimes, most of the time, or always spent time virtually (i.e., by using a computer, telephone, or other device) with family, friends, or others during the pandemic. The prevalence of feeling close to persons at school was higher among male students than female students. Being virtually connected to others during the pandemic did not vary by sex. The prevalence of feeling close to persons at school and being virtually connected to others varied by race and ethnicity. The prevalence of feeling close to persons at school was higher among White students than Black, Hispanic, and Asian students; higher among Hispanic, Asian, AI/AN, and multiracial students than Black students; and higher among multiracial students than Hispanic students. The prevalence of being virtually connected to others was higher among White students than Black and Hispanic students. The prevalence of feeling close to persons at school was higher among heterosexual students than gay, lesbian, or bisexual students and other or questioning students; however, being virtually connected to others during the pandemic did not vary by sexual identity.

Connectedness and Mental Health

Compared with those who did not feel close to persons at school, students who felt close to persons at school had a lower prevalence of poor mental health during the pandemic (28.4% versus 45.2%) and during the past 30 days (23.5% versus 37.8%), of persistent feelings of sadness or hopelessness (35.4% versus 52.9%), of having seriously considered attempting suicide (14.0% versus 25.6%), and of having attempted suicide (5.8% versus 11.9%) ( Figure ). Similarly, students who were virtually connected to others during the pandemic had a lower prevalence of poor mental health during the pandemic (35.5% versus 42.0%) and during the past 30 days (28.7% versus 36.8%), of persistent feelings of sadness or hopelessness (41.9% versus 51.7%), of having seriously considered attempting suicide (18.4 versus 24.9%), and of having attempted suicide (8.0% versus 12.2%) compared with those who were not virtually connected to others during the pandemic.

Persistent feelings of sadness or hopelessness, perceptions of mental health, and suicidal thoughts and attempts among high school students during the COVID-19 pandemic, by feeling close to persons at school* and being virtually connected † — Adolescent Behaviors and Experiences Survey, United States, January–June 2021

* All comparisons of having felt close versus not sure, disagree, or strongly disagree they felt close were significantly different, based on t -test analysis (p<0.05).

† All comparisons of being connected versus never or rarely felt connected were significantly different, based on t -test analysis (p<0.05).

More than one in three high school students (37.1%) experienced poor mental health during the COVID-19 pandemic. In addition, 44.2% of students experienced persistent feelings of sadness or hopelessness, almost 20% seriously considered suicide, and 9.0% attempted suicide during the 12 months before the survey. The prevalence of poor mental health and suicidality was high across students of all sex, sexual identity, and racial and ethnic groups; however, poor mental health, persistent feelings of sadness or hopelessness, and suicidal thoughts and behaviors were less prevalent among those who felt close to persons at school and were virtually connected with others during the pandemic.

During the COVID-19 pandemic, students’ feelings of being connected to school were likely reduced by extensive school closures and transitions to virtual learning ( 8 ). Efforts to improve connectedness to schools, peers, and family are critical to protecting the mental health and well-being of youths ( 9 ), particularly in the context of ongoing pandemic-related stressors. Evidence from previous outbreaks suggests that the pandemic might have long-term consequences for youth mental health and well-being and be associated with potential increases in youth depression, anxiety, and post-traumatic stress disorder, which underscores the urgent need to address mental health needs among youths ( 10 ).

In addition to providing youths with access to needed mental health care ( 11 ), comprehensive approaches that promote help-seeking behaviors, connections to trusted adults and supportive peers, and engagement in community activities have been shown to have many benefits including improved feelings of connectedness, better mental health, reduced risk for suicide, reduced prevalence of health risk behaviors, and better academic achievement ( 9 , 12 ). Positive experiences during childhood, including school connectedness, can build resilience and protect or buffer adults who have experienced multiple childhood traumas ( 13 ).

To foster school connectedness and promote positive school climates, school districts can implement schoolwide programs such as those focused on social and emotional learning, professional development for staff to improve classroom management, and strategies to foster relationships between students, their families, and school staff. Another way to foster school connectedness and promote positive school climates is for school districts to analyze school disciplinary policies to ensure they are being implemented equitably across racial and ethnic groups ( 9 , 14 , 15 ). In addition to engaging with their child’s school, parents and caregivers can build relationships with their child through open discussions and shared activities ( 15 ).

Limitations

General limitations to ABES are outlined in the overview report in this supplement ( 7 ). The findings in this report are subject to at least four specific limitations. First, the mental health and suicidality variables used in this study are important indicators of students’ mental well-being; however, the questions were not designed to diagnose clinical depression. Second, most students were virtually connected to others, such as family, friends, or other groups, during the pandemic. Among students who were never or rarely virtually connected, it is unknown if that was a function of more in-person interactions; individual choice; a lack of family, friends, or other groups with whom students could be connected; or a lack of access to the technology needed by the student or others with whom the student would connect. Third, the survey did not ask students to indicate whether, at the time of the survey or in weeks or months preceding the survey, they attended school in person, remotely, or both in person and remotely. Students’ method of attendance might be a confounder for the findings related to students’ feeling of connectedness. Finally, because this was a one-time survey, no longitudinal data from studies using the same data collection methods are available to directly compare pre- and postpandemic mental health status among youths.

Mental health issues among youths are an important public health concern during the ongoing COVID-19 pandemic. However, the findings in this report also indicate that poor mental health, persistent feelings of sadness or hopelessness, and suicidal thoughts and behaviors were less prevalent among those who felt close to persons at school and were virtually connected with others during the pandemic. Comprehensive strategies that improve connections with others at home, in the community, and at school might foster improved mental health among youths during and after the pandemic.

Conflicts of Interest: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

Experts reveal mental health impacts of mass shootings on young survivors

Experts said kids may experience a range of behavioral and psychological issues.

As the United States reels from yet another mass school shooting , experts warn that young children are suffering from its devastating impacts.

A total of three children, all age nine -- as well as three adults -- were killed at the Covenant School in Nashville in what President Joe Biden referred to as "sick" and "heartbreaking."

Children can respond in a wide range of ways including being numb to the event, being more angry or irritable, suffering from high anxiety and being fearful of going back to school, according to mental health experts.

"As a pediatrician, and as a father, I think it makes common sense that when kids are exposed to this sort of thing, that it would have potentially long-term consequences for them," Dr. Marc Gorelick, president and CEO of Children's Minnesota hospital, told ABC News.

MORE: How to talk to children about school shootings

He continued, "And the research actually bears that out, that there are, in fact, significant behavioral and psychological impacts on children who either are victims of or witness to or even around events, such as this shooting in Nashville."

Doctors told ABC News what signs parents can look out for and how to best help their children cope.

Mental health impact of witnesses to a shooting

Dr. Daniel Marullo, a clinical psychologist from Children's of Alabama Hospital, told ABC News that many children develop resilience , or an ability to overcome serious hardships.

However, he says gun violence can impact a child's mental health, especially if they are witness to such an event.

"What would be considered a typical reaction could range everywhere from changes in mood, including being sad, angry, irritable, lowered frustration tolerance to having sleep problems," he said. "Certainly, a child may be more prone to having some nightmares or scary dreams, you might see changes in appetite."

Marullo said children who experience a traumatic even such as a shooting may have more trouble focusing and concentrating or are more easily distracted.

Experts said responses can depend on age, as well.

'The impacts on them tend to fall into two categories," Gorelick said. "Like older kids, they will often have symptoms of post-traumatic stress, that could be nightmares, sleep problems, avoiding certain locations, including avoiding school, because of the associated trauma."

"Younger kids tend to have symptoms that reflect in things like withdrawal, depression, anxiety...in response to being a party to or witness to community violence, gun violence," he added.

Wide scale of emotional response

Dr. Scott Krakower, a child and adolescent psychiatrist at Northwell Health in New York, told ABC News that children can experience a wide range of emotions following a traumatic event.

MORE: Nashville school shooting: What to know about the 6 victims

Some children may be affected but may not show any emotion because they're numbed or withdrawn after the event, he explained.

"Everybody's different they might have more emotions, heightened levels of emotional states, avoidant behaviors, avoidance of the actual event itself, or memories related to the event, or going into even school itself, where they know that that's the trigger of them," Krakower said.

He continued, "Some of them probably have feelings of survivors' guilt, like, what if they could have done things differently for themselves?"

Children impacted indirectly

The effects are not just on the children who attended a school where a shooting occurred, but those who live in the surrounding community or even in another state.

About four in 10 Americans believe they may become a victim of gun violence within the next five years, according to a UChicago Harris/AP-NORC Poll released in August 2022.

"One of the sad things, for kids, you don't have to be that close to it to be affected by it and even just hearing about it on the news, knowing that it happened to kids like yourself, kids that you might know or kids in your community can have those same effects," Gorelick said.

"What parents should be looking for in their children in the aftermath of event like this is showing signs of anxiety, showing signs of fears, showing signs of being worried about themselves because of what they saw or heard about," he continued.

Resuming a normal routine

Experts say it's important to make sure children are provided as much structure as possible after a traumatic event to help with their development and well-being.

Amidst the chaos that follows a shooting, routines either at school or home can help reassure children that they will be okay.

MORE: Who was Nashville shooter Audrey Hale?

"One thing is to get back to normal, get back to routine," Marullo said. "Getting back to that kind of structure is very important. That really provides a sense of security for kids."

However, resuming routines doesn't mean pretending the event didn't happen, Marullo said, adding that adults should make sure children feel safe talking about their feelings.

"If a child brings up feeling scared, really validating that it's okay to feel that way and helping them understand that they are safe, and here's what we're doing to help you out," he said. "Just kind of recognize that this was scary, and you've got a right to be afraid, but giving them the tools to help them cope and manage."

The experts say some children may benefit from at least brief therapy, either working with a psychologist or a counselor to process any feelings or fears they're experiencing, even if they don't develop a psychological disorder.

Help support adults' needs

Experts say it's important that adults take care of their own needs after a traumatic event because helping them will, in turn, help their child.

"If you want to help your child, you've got to help yourself," Marullo said. "By an adult taking care of themselves, they are showing and demonstrating to their child or if they were a teacher to their class, how to cope and manage."

He explained that because children look to adults for safety and security, how adults cope with a traumatic event will influence how children do the same,

"So, it's not that you hide your emotions, but you manage your emotions, and it's okay to say, 'Look, I'm scared too, but this is what I'm going to do to feel better' or 'I'm upset, I'm angry, but here's how I'm going to use my anger,'" Marullo said.

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